| Network Provider Mix 2023 | |
|
209 E 7th St Madera CA 93638-3780 | |
| (559) 673-3508 | |
| (559) 675-4999 |
| Full Name | Network Provider Mix 2023 |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 209 E 7th St, Madera, California |
| Authorized Official Name and Position | Dennis P Koch (DIRECTOR BEHAVIORAL HEALTH SERVICES) |
| Authorized Official Contact | 5596733508 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Network Provider Mix 2023 Po Box 1288 Madera CA 93639-1288 Ph: (559) 673-3508 | Network Provider Mix 2023 209 E 7th St Madera CA 93638-3780 Ph: (559) 673-3508 |
| NPI Number | 1174838338 |
|---|---|
| Provider Enumeration Date | 08/12/2010 |
| Last Update Date | 12/07/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174838338 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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Network Provider Lcsw 2021 Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 209 E 7th St, Madera, CA 93638 Phone: 559-673-3508 Fax: 559-675-4999 | |
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Network Provider Phd 2020 Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 209 E 7th St, Madera, CA 93638 Phone: 559-673-3508 Fax: 559-675-4999 | |
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