Provider Demographics
NPI:1205372711
Name:CENTRAL VALLEY FAMILY THERAPY CORP
Entity Type:Organization
Organization Name:CENTRAL VALLEY FAMILY THERAPY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:TIHIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:559-691-6840
Mailing Address - Street 1:770 E SHAW AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-7708
Mailing Address - Country:US
Mailing Address - Phone:559-691-6840
Mailing Address - Fax:559-468-6141
Practice Address - Street 1:770 E SHAW AVE STE 230
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-7708
Practice Address - Country:US
Practice Address - Phone:559-691-6840
Practice Address - Fax:559-468-6141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-09
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81828106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9272042Medicaid