Provider Demographics
NPI:1619403235
Name:BICC CENTRAL CALIFORNIA
Entity Type:Organization
Organization Name:BICC CENTRAL CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-515-6485
Mailing Address - Street 1:1782 E BULLARD AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5868
Mailing Address - Country:US
Mailing Address - Phone:559-515-6485
Mailing Address - Fax:558-447-1567
Practice Address - Street 1:1782 E BULLARD AVE STE 104
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5868
Practice Address - Country:US
Practice Address - Phone:559-515-6485
Practice Address - Fax:558-447-1567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-02
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty