Healthcare Provider Details

I. General information

NPI: 1316676737
Provider Name (Legal Business Name): MATRIX BEHAVIORAL HEALTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2022
Last Update Date: 06/09/2022
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 S CENTRAL ST STE A
VISALIA CA
93277-4528
US

IV. Provider business mailing address

1810 S CENTRAL ST STE A
VISALIA CA
93277-4528
US

V. Phone/Fax

Practice location:
  • Phone: 559-635-4252
  • Fax: 559-635-4281
Mailing address:
  • Phone: 559-635-4252
  • Fax: 559-635-4281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: KIM DIANE GARZA
Title or Position: MANAGER
Credential:
Phone: 559-635-4252