Basic Information
| Provider Information | |||||||||
| NPI: | 1033597620 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DIALECTICAL BEHAVIOR THERAPY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 515 S CEDAR AVE | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937022908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596004099 | ||||||||
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| Practice Location | |||||||||
| Address1: | 515 S CEDAR AVE | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937022908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596004099 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2015 | ||||||||
| LastUpdateDate: | 05/14/2015 | ||||||||
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| AuthorizedOfficialLastName: | UTECHT | ||||||||
| AuthorizedOfficialFirstName: | DAWAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5596009193 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.