1508801192 NPI number — COUNTY OF TULARE HEALTH AND HUMAN SERVICES AGENCY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508801192 NPI number — COUNTY OF TULARE HEALTH AND HUMAN SERVICES AGENCY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF TULARE HEALTH AND HUMAN SERVICES AGENCY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NORTH VISALIA ADULT MENTAL HEALTH CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508801192
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5957 S MOONEY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VISALIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93277-9394
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-737-4669
Provider Business Mailing Address Fax Number:
559-737-4697

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2611 N DINUBA BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VISALIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93291-9003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-737-4350
Provider Business Practice Location Address Fax Number:
559-737-4254
Provider Enumeration Date:
06/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DUERKSEN
Authorized Official First Name:
CHERYL
Authorized Official Middle Name:
L
Authorized Official Title or Position:
DIRECTOR OF MENTAL HEALTH
Authorized Official Telephone Number:
559-737-4669

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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