Healthcare Provider Details

I. General information

NPI: 1609248483
Provider Name (Legal Business Name): MADERA COUNTY BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2015
Last Update Date: 10/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 N R ST SUITE 101
MADERA CA
93637-4465
US

IV. Provider business mailing address

117 N R ST SUITE 101
MADERA CA
93637-4465
US

V. Phone/Fax

Practice location:
  • Phone: 559-662-0527
  • Fax:
Mailing address:
  • Phone: 559-662-0527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. ANNETTE R PRESLEY
Title or Position: SUPERVISING HEALTH CLINICIAN
Credential: LCSW
Phone: 559-662-0527