Healthcare Provider Details

I. General information

NPI: 1467265223
Provider Name (Legal Business Name): COUNTY OF TULARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 01/27/2025
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11200 AVENUE 368
VISALIA CA
93291-8940
US

IV. Provider business mailing address

5957 S MOONEY BLVD
VISALIA CA
93277-9394
US

V. Phone/Fax

Practice location:
  • Phone: 559-624-8480
  • Fax:
Mailing address:
  • Phone: 559-624-8480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP2400X
TaxonomyPrison Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STACI CHASTAIN
Title or Position: DEP HHS DIR, PUBLIC HEALTH OPS
Credential:
Phone: 559-624-8480