Provider Demographics
NPI:1861016842
Name:VALLEY HARVEST CHURCH OF MERCED
Entity Type:Organization
Organization Name:VALLEY HARVEST CHURCH OF MERCED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:PROF
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:JACKSON
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MA ORG BEHAV/MENT H
Authorized Official - Phone:209-756-6777
Mailing Address - Street 1:PO BOX 2771
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95344-0771
Mailing Address - Country:US
Mailing Address - Phone:209-756-6777
Mailing Address - Fax:209-723-4344
Practice Address - Street 1:557 W 26TH ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-2825
Practice Address - Country:US
Practice Address - Phone:209-756-6777
Practice Address - Fax:209-723-4344
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VALLEY HARVEST CHURCH OF MERCED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty