Healthcare Provider Details

I. General information

NPI: 1902946635
Provider Name (Legal Business Name): FRESNO COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3109 N MILLBROOK AVE
FRESNO CA
93703-1425
US

IV. Provider business mailing address

3109 N MILLBROOK AVE
FRESNO CA
93703-1425
US

V. Phone/Fax

Practice location:
  • Phone: 559-253-9180
  • Fax:
Mailing address:
  • Phone: 559-253-9180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number000001098
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number000001098
License Number State

VIII. Authorized Official

Name: SUSAN LEIGH HOLT
Title or Position: DIRECTOR
Credential:
Phone: 559-600-9058