Basic Information
| Provider Information | |||||||||
| NPI: | 1467774950 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | VISALIA YOUTH SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 711 N COURT ST | ||||||||
| Address2: | |||||||||
| City: | VISALIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932913638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592863990 | ||||||||
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| Practice Location | |||||||||
| Address1: | 711 N COURT ST | ||||||||
| Address2: | |||||||||
| City: | VISALIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932913638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596271490 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2010 | ||||||||
| LastUpdateDate: | 07/12/2012 | ||||||||
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| AuthorizedOfficialLastName: | GARCIA | ||||||||
| AuthorizedOfficialFirstName: | NORMA | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | INTERN | ||||||||
| AuthorizedOfficialTelephone: | 5593336321 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | INTERN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 67660 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.