| Fee For Service - Mfcc | |
|
800 Scenic Dr Modesto CA 95350-6131 | |
| (209) 558-4752 | |
| Not Available |
| Full Name | Fee For Service - Mfcc |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 800 Scenic Dr, Modesto, California |
| Authorized Official Name and Position | Ruben Imperial (BEHAVIORAL HEALTH INTERIM DIRECTOR) |
| Authorized Official Contact | 2095256225 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fee For Service - Mfcc 800 Scenic Dr Modesto CA 95350-6131 Ph: () - | Fee For Service - Mfcc 800 Scenic Dr Modesto CA 95350-6131 Ph: (209) 558-4752 |
| NPI Number | 1972704682 |
|---|---|
| Provider Enumeration Date | 05/30/2007 |
| Last Update Date | 10/15/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972704682 | NPI | - | NPPES |
| 5057 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
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