Healthcare Provider Details

I. General information

NPI: 1013634294
Provider Name (Legal Business Name): PSYCO KULTURE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2022
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8050 N PALM AVE STE 300
FRESNO CA
93711-5510
US

IV. Provider business mailing address

8050 N PALM AVE STE 300
FRESNO CA
93711-5510
US

V. Phone/Fax

Practice location:
  • Phone: 559-421-0291
  • Fax:
Mailing address:
  • Phone: 559-421-0291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: MR. THEDFORD LEWIS JONES JR.
Title or Position: MEMBER
Credential:
Phone: 559-421-0291