Healthcare Provider Details

I. General information

NPI: 1467774950
Provider Name (Legal Business Name): VISALIA YOUTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2010
Last Update Date: 07/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 N COURT ST
VISALIA CA
93291-3638
US

IV. Provider business mailing address

711 N COURT ST
VISALIA CA
93291-3638
US

V. Phone/Fax

Practice location:
  • Phone: 559-627-1490
  • Fax:
Mailing address:
  • Phone: 559-286-3990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number67660
License Number StateCA

VIII. Authorized Official

Name: MRS. NORMA E GARCIA
Title or Position: INTERN
Credential: INTERN
Phone: 559-333-6321