Basic Information
| Provider Information | |||||||||
| NPI: | 1699130328 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COUNTY OF FRESNO-DEPARTMENT OF BEHAVIORAL HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3133 N MILLBROOK AVE | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937031425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596009180 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3133 N MILLBROOK AVE | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937031425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596009180 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2015 | ||||||||
| LastUpdateDate: | 12/22/2015 | ||||||||
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| AuthorizedOfficialLastName: | HILLE | ||||||||
| AuthorizedOfficialFirstName: | BRENDA | ||||||||
| AuthorizedOfficialMiddleName: | DAWN | ||||||||
| AuthorizedOfficialTitleorPosition: | UNLICENSED MENTAL HEALTH CLINICIAN | ||||||||
| AuthorizedOfficialTelephone: | 5596009180 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.A. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0850X | IMF86330 | CA | N | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | 261QM0855X | IMF86330 | CA | N | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | 251S00000X | IMF86330 | CA | Y | Agencies | Community/Behavioral Health |
No ID Information.