Provider Demographics
NPI:1417240383
Name:BEJARANO, VIDAL MICHAEL (ASW)
Entity Type:Individual
Prefix:
First Name:VIDAL
Middle Name:MICHAEL
Last Name:BEJARANO
Suffix:
Gender:M
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4376
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93744-4376
Mailing Address - Country:US
Mailing Address - Phone:559-245-1159
Mailing Address - Fax:559-495-3650
Practice Address - Street 1:3333 E AMERICAN AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93725-9247
Practice Address - Country:US
Practice Address - Phone:559-600-4881
Practice Address - Fax:559-495-3650
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CA111806101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)