Provider Demographics
NPI:1235314246
Name:HOUSE PSYCHIATRIC CLINIC, INC.
Entity Type:Organization
Organization Name:HOUSE PSYCHIATRIC CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:BENIJAH JUDSON
Authorized Official - Last Name:HOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:559-226-1316
Mailing Address - Street 1:1322 E SHAW AVE
Mailing Address - Street 2:SUITE 410
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-0000
Mailing Address - Country:US
Mailing Address - Phone:559-226-1316
Mailing Address - Fax:559-226-1315
Practice Address - Street 1:1322 E SHAW AVE
Practice Address - Street 2:SUITE 410
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-0000
Practice Address - Country:US
Practice Address - Phone:559-226-1316
Practice Address - Fax:559-226-1315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2OA78882084P0800X, 261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ06991ZMedicare PIN