Basic Information
| Provider Information | |||||||||
| NPI: | 1750439857 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FRESNO COUNTY DCFS-CHILDREN'S MENTAL HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1779 E FALLBROOK AVE | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937202792 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592987408 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3133 N MILLBROOK AVE | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937031425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594538405 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | NGUYEN | ||||||||
| AuthorizedOfficialFirstName: | GIANG | ||||||||
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| AuthorizedOfficialTitleorPosition: | STATE CONTACT | ||||||||
| AuthorizedOfficialTelephone: | 5594538918 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MISS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | IMF 48397 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.