Provider Demographics
NPI:1346094729
Name:CALIFORNIA CONSORTIUM FOR PREVENTION AND INTERVENTION
Entity Type:Organization
Organization Name:CALIFORNIA CONSORTIUM FOR PREVENTION AND INTERVENTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:CASADOS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:559-813-0461
Mailing Address - Street 1:16183 SAMPLE RD
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-9708
Mailing Address - Country:US
Mailing Address - Phone:559-813-0461
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:559-813-0461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Multi-Specialty
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty