Healthcare Provider Details

I. General information

NPI: 1871088138
Provider Name (Legal Business Name): PROMESA BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2018
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 E MINARETS AVE
FRESNO CA
93720
US

IV. Provider business mailing address

7120 N MARKS AVE STE 110
FRESNO CA
93711-0268
US

V. Phone/Fax

Practice location:
  • Phone: 559-439-5437
  • Fax:
Mailing address:
  • Phone: 559-341-2394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number100407405
License Number StateCA

VIII. Authorized Official

Name: AMANDA IRENE REED
Title or Position: DIRECTOR
Credential: LMFT
Phone: 559-439-5437