Provider Demographics
NPI:1285219600
Name:FRESNO COUNTY SUPERINTENDENT OF SCHOOLS
Entity Type:Organization
Organization Name:FRESNO COUNTY SUPERINTENDENT OF SCHOOLS
Other - Org Name:ALL4YOUTH EAST SIDE HUB
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:559-363-2095
Mailing Address - Street 1:2440 TULARE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-2281
Mailing Address - Country:US
Mailing Address - Phone:559-443-4800
Mailing Address - Fax:
Practice Address - Street 1:4939 E YALE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-1523
Practice Address - Country:US
Practice Address - Phone:559-443-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-17
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health