Provider Demographics
NPI:1699827576
Name:SUPPORTED EDUCATION EMPLOYMENT SERVICES
Entity Type:Organization
Organization Name:SUPPORTED EDUCATION EMPLOYMENT SERVICES
Other - Org Name:JOB OPTIONS
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR, DEPARTMENT OF BEHAVIORAL
Authorized Official - Prefix:
Authorized Official - First Name:DAWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:UTECHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-600-9193
Mailing Address - Street 1:4447 E KINGS CANYON ROAD, UNIT E
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93702
Mailing Address - Country:US
Mailing Address - Phone:559-452-3463
Mailing Address - Fax:559-452-3470
Practice Address - Street 1:4447 E KINGS CANYON ROAD, UNIT E
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703
Practice Address - Country:US
Practice Address - Phone:559-453-8637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF FRESNO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-18
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
2150OtherCOST CENTER
2193OtherCOST CENTER
2170OtherCOST CENTER
2189OtherCOST CENTER
CA000001007Medicaid
2179OtherCOST CENTER
2193OtherCOST CENTER