Basic Information
| Provider Information | |||||||||
| NPI: | 1871681171 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FRESNO COUNTY, DCFS- CHILDREN'S MENTAL HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4441 E. KINGS CANYON | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937023604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594538918 | ||||||||
| FaxNumber: | 5594536700 | ||||||||
| Practice Location | |||||||||
| Address1: | 3133 N. MILLBROOK | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594538918 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | NGUYEN | ||||||||
| AuthorizedOfficialFirstName: | GIANG | ||||||||
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| AuthorizedOfficialTitleorPosition: | SENIOR LICENSED CLINICIAN | ||||||||
| AuthorizedOfficialTelephone: | 5594538918 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 302R00000X | 1041000000X | CA | Y | Managed Care Organizations | Health Maintenance Organization |
No ID Information.