=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750715801
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KINGS COUNTY BEHAVIORAL HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/26/2013
-----------------------------------------------------
Last Update Date | 11/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1222 W LACEY BLVD FL 2
-----------------------------------------------------
City | HANFORD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93230-5901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-852-2444
-----------------------------------------------------
Fax | 559-589-6916
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1400 W LACEY BLVD BLDG 13
-----------------------------------------------------
City | HANFORD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93230-5905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-582-2444
-----------------------------------------------------
Fax | 559-589-6916
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | DR. LISA LEWIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 559-852-2444
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------