Provider Demographics
NPI:1083153324
Name:FRESNO COUNTY
Entity Type:Organization
Organization Name:FRESNO COUNTY
Other - Org Name:FRESNO COUNTY DBH - MOD D
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HOLT
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:559-600-9058
Mailing Address - Street 1:4452 E KINGS CANYON RD
Mailing Address - Street 2:BUILDING #01
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93702
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4452 E KINGS CANYON RD
Practice Address - Street 2:BUILDING #01
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93702
Practice Address - Country:US
Practice Address - Phone:559-600-9199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-20
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)