| Full Name | |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 1105 S O St, Tulare, California |
| Authorized Official Name and Position | Jeff Fly (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 5597328086 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
220 N Locust St Visalia CA 93291-4946 Ph: (559) 627-1385 | 1105 S O St Tulare CA 93274-6531 Ph: (559) 688-2623 |
| NPI Number | 1043437593 |
|---|---|
| Provider Enumeration Date | 04/19/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043437593 | NPI | - | NPPES |
| 5478 | Other | CA | DRUG MEDI-CAL |
| 540007BN | Other | CA | ADP CERT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 540007BN (California) | Primary |
Central County One Stop Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 810 N Cherry St, Tulare, CA 93274 Phone: 559-687-8713 | |
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My Mental Pro Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3014 Ryan Ave, Tulare, CA 93274 Phone: 559-656-7688 | |