Basic Information
| Provider Information | |||||||||
| NPI: | 1396873154 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RICE | ||||||||
| FirstName: | TROY | ||||||||
| MiddleName: | |||||||||
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| Credential: | MA MFTI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1617 E SAGINAW WAY | ||||||||
| Address2: | #102 | ||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937044458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592740299 | ||||||||
| FaxNumber: | 5592440328 | ||||||||
| Practice Location | |||||||||
| Address1: | 1617 E SAGINAW WAY | ||||||||
| Address2: | #102 | ||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937044458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592740299 | ||||||||
| FaxNumber: | 5592440328 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2007 | ||||||||
| LastUpdateDate: | 05/02/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 171M00000X | CA | N | Other Service Providers | Case Manager/Care Coordinator | 106H00000X | 63491 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | 1669559878 | 01 | CA | MEDI-CAL | OTHER |