Healthcare Provider Details

I. General information

NPI: 1518095488
Provider Name (Legal Business Name): VIOLET HEINTZ EDUCATION ACADEMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 09/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4939 E YALE AVE
FRESNO CA
93727
US

IV. Provider business mailing address

3133 N MILLBROOK
FRESNO CA
93703-1425
US

V. Phone/Fax

Practice location:
  • Phone: 559-443-4850
  • Fax:
Mailing address:
  • Phone: 559-453-8918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number000001091
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAWAN UTECHT
Title or Position: DIREC DEP BEH HEALTH
Credential:
Phone: 559-600-6895