Healthcare Provider Details

I. General information

NPI: 1639568983
Provider Name (Legal Business Name): MENTAL HEALTH SYSTEMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2015
Last Update Date: 01/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 W CLINTON AVE
FRESNO CA
93705-4201
US

IV. Provider business mailing address

2022 DECATUR AVE
CLOVIS CA
93611-8101
US

V. Phone/Fax

Practice location:
  • Phone: 559-264-7521
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: CAROLYN KIDD
Title or Position: CBT FACILITATOR
Credential:
Phone: 559-264-7521