MEDICARE: FRESNO COUNTY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	305R00000X	Preferred Provider Organization

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	XXXX	OTHER	CA	DEPARTMENT OF MENTAL HEALTH

General Provider Information

NPI Number	:	1083936785
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRESNO COUNTY

Provider Business Mailing Address
First Line	:	142 E CALIFORNIA AVE.
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93706-3642
Country	:	US
Telephone Number	:	559-453-8270
Fax Number	:	559-453-3355

Provider Business Practice Location Address
First Line	:	142 E CALIFORNIA AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93706
Country	:	US
Telephone Number	:	559-453-8270
Fax Number	:	559-453-3355

Authorized Official
Title or Position	:	DIRECTOR
Name	:	SUSAN LEIGH HOLT
Credential	:	LMFT
Telephone Number	:	559-600-9058

Provider Enumeration Date	:	02/22/2010
Last Update Date	:	05/26/2026

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Directions to “FRESNO COUNTY ” Practice Location

Language	Start Address	Practice Location

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