Provider Demographics
NPI:1154591121
Name:PROMESA BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:PROMESA BEHAVIORAL HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:559-341-2394
Mailing Address - Street 1:7120 N MARKS AVE # 110
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-0268
Mailing Address - Country:US
Mailing Address - Phone:559-439-5437
Mailing Address - Fax:559-439-5411
Practice Address - Street 1:7120 N MARKS AVE # 110
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711
Practice Address - Country:US
Practice Address - Phone:559-439-5437
Practice Address - Fax:559-439-5411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CA100043AN251S00000X
CA1044261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101044Medicaid
CA1044Medicaid