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General NPI Number Information
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NPI Number | 1750770293
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Entity Type | Organization
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Legal Business Name | CALIFORNIA MENTAL HEALTH
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Dates
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Enumeration Date | 01/22/2015
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Last Update Date | 02/11/2019
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Provider Practice Location Address
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Address Line | 4736 N VAGEDES AVE
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City | FRESNO
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State | CA
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Zip | 93705-0618
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Country | US
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Telephone | 559-512-0339
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Fax |
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Provider Business Mailing Address
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Address Line | 13810 CLIMBING WAY
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City | NEVADA CITY
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State | CA
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Zip | 95959-9649
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Country | US
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Telephone | 530-273-1112
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Fax | 530-273-1112
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Authorized Official
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Title or Position | OWNER
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Name | ANDREW MCVICKER
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Credential |
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Telephone | 559-512-0339
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 14302
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License Number State | CA
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