Healthcare Provider Details

I. General information

NPI: 1568951663
Provider Name (Legal Business Name): VALLEY HOPE COMMUNITY PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2018
Last Update Date: 05/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3340 TULLY RD STE D4
MODESTO CA
95350-0852
US

IV. Provider business mailing address

3340 TULLY RD STE D4
MODESTO CA
95350-0852
US

V. Phone/Fax

Practice location:
  • Phone: 209-496-4162
  • Fax:
Mailing address:
  • Phone: 209-496-4162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number27701
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number70497
License Number StateCA

VIII. Authorized Official

Name: DR. MICHAEL KELLY ABBOTT
Title or Position: PSYCHOLOGIST
Credential: PSYD
Phone: 209-596-4162