Provider Demographics
NPI:1356865679
Name:FRESNO MENTAL PSYCHOLOGICAL HEALTH SERVICES, P.C.
Entity type:Organization
Organization Name:FRESNO MENTAL PSYCHOLOGICAL HEALTH SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CHARMAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:RADELLANT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:559-307-9505
Mailing Address - Street 1:4021 N FRESNO ST STE 101
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-4030
Mailing Address - Country:US
Mailing Address - Phone:559-307-9505
Mailing Address - Fax:
Practice Address - Street 1:4021 N FRESNO STREET, STE. 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726
Practice Address - Country:US
Practice Address - Phone:559-307-9505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)