MEDICARE: FRESNO COUNTY EAST COUNTY REGIONAL MH CLINIC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2331	OTHER		COST CENTER

General Provider Information

NPI Number	:	1699828319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRESNO COUNTY EAST COUNTY REGIONAL MH CLINIC

Provider Business Mailing Address
First Line	:	4441 E KINGS CANYON RD
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93702-3604
Country	:	US
Telephone Number	:	559-253-9180
Fax Number	:

Provider Business Practice Location Address
First Line	:	225 ACADEMY AVE
Second Line	:
City	:	SANGER
State	:	CA
Zip	:	93657-2128
Country	:	US
Telephone Number	:	559-875-7705
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR, FRESNO CO MENTAL HEALTH
Name	:	MRS. GIANG T NGUYEN
Credential	:
Telephone Number	:	559-253-9180

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	08/22/2020

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