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General NPI Number Information
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NPI Number | 1801318316
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Entity Type | Organization
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Legal Business Name | DEPARTMENT OF BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 07/17/2017
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Last Update Date | 07/19/2017
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Provider Practice Location Address
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Address Line | 2025 E DAKOTA AVE
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City | FRESNO
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State | CA
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Zip | 93726-4804
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Country | US
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Telephone | 559-600-5755
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Fax |
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Provider Business Mailing Address
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Address Line | 2025 E DAKOTA AVE
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City | FRESNO
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State | CA
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Zip | 93726-4804
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LCSW
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Name | ELSA MARIE HERNANDEZ
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Credential |
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Telephone | 559-600-5755
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 76088
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License Number State |
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