Provider Demographics
NPI:1750702478
Name:KINGSVIEW COUSELING SERVICES FOR KINGS COUNTY
Entity type:Organization
Organization Name:KINGSVIEW COUSELING SERVICES FOR KINGS COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AOD COUSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIER
Authorized Official - Middle Name:JOHNSON
Authorized Official - Last Name:MANGINE
Authorized Official - Suffix:
Authorized Official - Credentials:M1202071247
Authorized Official - Phone:559-582-4412
Mailing Address - Street 1:2811 W PEREZ CT
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-3129
Mailing Address - Country:US
Mailing Address - Phone:559-737-1370
Mailing Address - Fax:
Practice Address - Street 1:2811 W PEREZ CT
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-3129
Practice Address - Country:US
Practice Address - Phone:559-737-1370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-23
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAM1202071247171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty