MEDICARE: BINGHAM MARRIAGE & FAMILY THERAPY, INC.

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	251300000X	Local Education Agency (LEA)	MFC38630	CA

General Provider Information

NPI Number	:	1316219728
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BINGHAM MARRIAGE & FAMILY THERAPY, INC.

Provider Business Mailing Address
First Line	:	1553 W SHAW AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93711-3503
Country	:	US
Telephone Number	:	559-261-4008
Fax Number	:	559-261-4009

Provider Business Practice Location Address
First Line	:	1553 W SHAW AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93711-3503
Country	:	US
Telephone Number	:	559-261-4008
Fax Number	:	559-261-4009

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	MR. TODD HOWARD BINGHAM
Credential	:	MA
Telephone Number	:	559-261-4008

Provider Enumeration Date	:	01/31/2012
Last Update Date	:	01/31/2012

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