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General NPI Number Information
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NPI Number | 1386942316
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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 | 02/28/2011
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Last Update Date | 02/28/2011
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Provider Practice Location Address
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Address Line | 211 SMOOT AVE
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City | MENDOTA
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State | CA
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Zip | 93640-2234
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Country | US
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Telephone | 559-655-4471
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Fax | 559-655-3226
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Provider Business Mailing Address
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Address Line | 7475 N PALM AVE STE 107
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City | FRESNO
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State | CA
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Zip | 93711-5763
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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 | CEO
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Name | LISA WEIGANT
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Credential | MA
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Telephone | 559-439-5437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 101044
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License Number State | CA
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