Healthcare Provider Details

I. General information

NPI: 1619092020
Provider Name (Legal Business Name): MADERA COUNTY BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14277 ROAD 28
MADERA CA
93638-5715
US

IV. Provider business mailing address

14277 ROAD 28
MADERA CA
93638-5715
US

V. Phone/Fax

Practice location:
  • Phone: 559-673-3508
  • Fax: 559-661-2818
Mailing address:
  • Phone: 559-673-3508
  • Fax: 559-661-2818

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. JANICE MELTON
Title or Position: DIRECTOR
Credential: LCSW
Phone: 559-675-7926