Provider Demographics
NPI:1689809097
Name:FRESNO COUNTY BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:FRESNO COUNTY BEHAVIORAL HEALTH
Other - Org Name:MENDOTA CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:MENTAL HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GIANG
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:559-452-3463
Mailing Address - Street 1:5108 E CLINTON WAY
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-2043
Mailing Address - Country:US
Mailing Address - Phone:559-452-3470
Mailing Address - Fax:
Practice Address - Street 1:121 BARBOSA ST.
Practice Address - Street 2:
Practice Address - City:MENDOTA
Practice Address - State:CA
Practice Address - Zip Code:93640
Practice Address - Country:US
Practice Address - Phone:559-846-7500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-29
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)