Provider Demographics
NPI:1164150686
Name:ENDEAVOR BEHAVIORAL HEALTH GROUP
Entity Type:Organization
Organization Name:ENDEAVOR BEHAVIORAL HEALTH GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RECENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:916-295-2969
Mailing Address - Street 1:1911 N FINE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-1510
Mailing Address - Country:US
Mailing Address - Phone:916-295-2969
Mailing Address - Fax:
Practice Address - Street 1:1911 N FINE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-1510
Practice Address - Country:US
Practice Address - Phone:559-458-0210
Practice Address - Fax:559-251-9024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-11
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty