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General NPI Number Information
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NPI Number | 1154591121
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Entity Type | Organization
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Legal Business Name | PROMESA BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 03/06/2008
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | 7120 N MARKS AVE # 110
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City | FRESNO
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State | CA
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Zip | 93711
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Country | US
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Telephone | 559-439-5437
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Fax | 559-439-5411
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Provider Business Mailing Address
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Address Line | 7120 N MARKS AVE # 110
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City | FRESNO
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State | CA
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Zip | 93711-0268
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Country | US
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Telephone | 559-439-5437
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Fax | 559-439-5411
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Authorized Official
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Title or Position | DIRECTOR
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Name | AMANDA IRENE REED
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Credential | LMFT
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Telephone | 559-341-2394
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 1044
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 100043AN
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License Number State | CA
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