Healthcare Provider Details

I. General information

NPI: 1083019822
Provider Name (Legal Business Name): BELLA VISTA BEHAVIOR SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2014
Last Update Date: 10/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2316 W WHITENDALE AVE SUITE B, #4
VISALIA CA
93277-6131
US

IV. Provider business mailing address

PO BOX 25042
FRESNO CA
93729-5042
US

V. Phone/Fax

Practice location:
  • Phone: 559-372-8175
  • Fax:
Mailing address:
  • Phone: 559-892-4531
  • Fax: 559-892-4550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: JESSIKA N FEIL
Title or Position: EXECUTIVE DIRECTOR
Credential: BCBA
Phone: 559-372-8175