Healthcare Provider Details

I. General information

NPI: 1043479678
Provider Name (Legal Business Name): CENTRAL COUNTY ONE STOP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 06/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 N CHERRY ST
TULARE CA
93274-2208
US

IV. Provider business mailing address

810 N CHERRY ST
TULARE CA
93274-2208
US

V. Phone/Fax

Practice location:
  • Phone: 559-687-8713
  • Fax:
Mailing address:
  • Phone: 559-687-8713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. CLAUDIA GONZALES
Title or Position: MHSA COORDINATOR
Credential: MFT
Phone: 559-732-8086