HomeMy WebLinkAboutAgreement A-24-667 Amendment No. 5 to Master Agreement.pdf Agreement No. 24-667
1 AMENDMENT NO. 5 TO SERVICE AGREEMENT
2 This Amendment No. 5 to Service Agreement ("Amendment No. 5") is dated
3 December 17, 2024 and is by and between the County of Fresno, a political subdivision of
4 the State of California ("County"), and each Provider listed in Revised Exhibit A-4, "List of
5 Providers" (collectively referred to as "Provider"). Reference in this Agreement to "party" or
6 "parties" shall be understood to refer to County and each provider unless otherwise specified.
7 Recitals
8 A. On June 23, 2020, the County and Provider entered into Individual/Group Provider
9 Master Agreement, which is County Agreement No. 20-236, for specialty mental health services
10 to County's Medi-Cal beneficiaries; and
11 B. On June 30, 2023, the County and Provider amended the above service Agreement,
12 which is Agreement No. 23-271 to add additional Providers to the Agreement and incorporate a
13 new billing structure due to the implementation of the California Advancing and Innovating Medi-
14 Cal (CaIAIM) initiative by the Department of Health Care Services; and
15 C. On January 9, 2024 the County and Provider amended the above service Agreement,
16 which is Agreement No. 24-021 to add additional providers to the Agreement; and
17 D. On May 21, 2024 the County and Provider amended the above service Agreement,
18 which is Agreement No. 24-217 to add additional providers to the Agreement, remove providers
19 from the Agreement, and increase maximum compensation to the Agreement; and
20 E. On November 5, 2024 the County and Provider amended the above service Agreement
21 which is Agreement No. 24-574 to add additional providers to the Agreement; and
22 F. The County now desires to retroactively increase the maximum compensation for this
23 Agreement for fiscal years 2023-2024 and 2024-2025 due to an unexpected increase in
24 reimbursable services; and upon execution of this Amendment No. 5, update individual provider
25 Karina Cisneros to Karina Baca due to her legal name changing.
26 The parties therefore agree as follows:
27 1. Section 4 of the Agreement located at page 6 line 23 through page 7 line 3 is deleted
28 and replaced with the following:
1
1 "For the period effective from July 1, 2023 through June 30, 2024, the maximum
2 compensation amount under this Agreement shall not exceed Seven Million Five
3 Hundred Thousand and No/100 Dollars ($7,500,000.00) for all Providers
4 combined.
5 For the period effective from July 1, 2024 through June 30, 2025, the maximum
6 compensation amount under this Agreement shall not exceed Eight Million and
7 No/100 Dollars ($8,000,000.00) for all Providers combined.
8 For the entire term of this Agreement, the total maximum compensation amount
9 under this Agreement shall not exceed Twenty Eight Million Seven Hundred
10 Thirty Nine Thousand Eight Hundred Thirty Eight and No/100 Dollars
11 ($28,739,838.00) for all Providers combined."
12 2. This Amendment No. 5 is effective retroactive to July 1, 2023, unless otherwise indicated
13 in this Amendment No. 5.
14 3. When both parties have signed this Amendment No. 5, the Agreement, Amendment No.
15 1, Amendment No. 2, Amendment No. 3, Amendment No. 4, and this Amendment No. 5
16 together constitute the Agreement.
17 4. The Contractor represents and warrants to the County that:
18 a. The Contractor is duly authorized and empowered to sign and perform its obligations
19 under this Amendment.
20 b. The individual signing this Amendment on behalf of the Contractor is duly authorized
21 to do so and his or her signature on this Amendment legally binds the Contractor to
22 the terms of this Amendment.
23 5. The parties agree that this Amendment may be executed by electronic signature as
24 provided in this section.
25 a. An "electronic signature" means any symbol or process intended by an individual
26 signing this Amendment to represent their signature, including but not limited to (1) a
27 digital signature; (2) a faxed version of an original handwritten signature; or (3) an
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1 electronically scanned and transmitted (for example by PDF document) version of an
2 original handwritten signature.
3 b. Each electronic signature affixed or attached to this Amendment (1) is deemed
4 equivalent to a valid original handwritten signature of the person signing this
5 Amendment for all purposes, including but not limited to evidentiary proof in any
6 administrative or judicial proceeding, and (2) has the same force and effect as the
7 valid original handwritten signature of that person.
8 c. The provisions of this section satisfy the requirements of Civil Code section 1633.5,
9 subdivision (b), in the Uniform Electronic Transaction Act (Civil Code, Division 3, Part
10 2, Title 2.5, beginning with section 1633.1).
11 d. Each party using a digital signature represents that it has undertaken and satisfied
12 the requirements of Government Code section 16.5, subdivision (a), paragraphs (1)
13 through (5), and agrees that each other party may rely upon that representation.
14 e. This Amendment is not conditioned upon the parties conducting the transactions
15 under it by electronic means and either party may sign this Amendment with an
16 original handwritten signature.
17 6. This Amendment may be signed in counterparts, each of which is an original, and all of
18 which together constitute this Amendment.
19 7. The Agreement as previously amended and as amended by this Amendment No. 5 is
20 ratified and continued. All provisions of the Agreement as previously amended and not
21 amended by this Amendment No. 5 remain in full force and effect.
22 [SIGNATURE PAGE FOLLOWS]
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1 The parties are signing this Amendment No. 5 on the date stated in the introductory
2 clause.
3
PROVIDERS COUNTY OF FRESNO
4
SEE ATTACHED SIGNATURE PAGES
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6 Nathan Magsig, Chairman of the Board of
Supervisors of the County of Fresno
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Attest:
8 Bernice E. Seidel
Clerk of the Board of Supervisors
9 County of Fresno, State of California
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By:
11 Deputy
12 For accounting use only:
13 Org No.: 56302666
Account No.: 7223/0
14 Fund No.: 0001
Subclass No.: 10000
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The parties are executing this Amendment No. 5 to Agreement No. 20-236 on the date
2 stated in the introductory clause.
3 Provider(individual): Dolores Amato —
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1 The parties are executing this Amendment No. 5 to Agreement No. 20-236 on the date stated in
the introductory clause.
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Provider (Individual): Karina Baca
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By:
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Print Name: Karina Baca
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Title: LCSW
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10 Date: 11/18/2024
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1 The parties are executing this Amendment No. 5 to Agreement No. 20-236 on the date stated in
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Provider (Individual): Johanna V. Cooke
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6 Johanna Cooke, LCSW
Print Name.
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8 Title: Licensed Clinical Social Worker
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Date: 11/19/2024
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1 The parties are executing this Amendment No. 5 to Agreement No. 20-236 on the date stated in
the introductory clause
Provider (Individual): Juddh A. Dickey
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By:
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Title
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1 The parties are executing this Amendment No. 5 to Agreement No. 20-236 on the data stated in
the introductory clause.
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Provider(individual): Donald Farris
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By:
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6 Print Name: Donald K Farris
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8 Title: LCSW
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10 Date: 11/20/2024
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1 The partiesmreexeouUngUliaAmendnnantNo. 5toAoneemerdNo. 2O-230onthadateatetadin
the introductory clause.
Provider(individual): Kimberly M. Jones
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By:
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Print Name: __Dr. Kimberly Jones, Ed.D. LK8FT#4995
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Title: —Owner
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OmN»: 11/2O/2O
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j1 The parties are executing this Amendment No. 5 to Agreement No. 20-236 on the date stated in
the introductory clause.
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3 Provide r(Indi idual): L Familia Thera Services Inc.
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By:
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Print Name: 1,11*116L-1
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Title: C, d- L �'1 F 7-
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Date:
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1 The parties are executing this Amendment No. 5 to Agreement No. 20-236 on the date stated in
the introductory clause.
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Provider (Individual): Nasim Nancy Lynch
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By:
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Print Name: d"'la G v
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Title:
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1 The parties are executing this Amendment No. 5 to Agreement No. 20-236 on the date stated in
the introductory clause.
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Provider (In u ): Eri McClinc .
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By:
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Print Name: Erica Mccl;ncy
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Title: Licensed clinical Social Worker
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Date: 11/2ni24
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1 The parties are executing this Amendment No. 5 to Agreement No. 20-236 on the date stated in
2 the introductory clause.
3 Provider (Individual): Kannon E. Nalls
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1 The parties are executing this Amendment No. 5 to Agreement No. 20-236 on the date stated i
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3 Provider (In vi ual): Isa intanilla
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1 The parties are executing this Amendment No. 5 to Agreement No. 20-236 on the date stated in
the introductory clause.
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Provider(Individual): Juan Quintanilla
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By:
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Print Name: —: U� �111VIlTr�hPrL�
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Title:
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Date: �� /
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1 The parties are executing this Amendment No. 5 to Agreement No. 20-236 on the date stated in
the introductory clause.
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Provider (individual): Michelle Randolph
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Title: -C�`.'
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1 The parties are executing this Amendment No. 5 to Agreement No. 20-236 on the date stated in
the introductory clause.
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Provider (Individual): Teresa Roltgen
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By:
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Print Name: re—y-C, G, �"-
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Title: �t I
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1 The parties are executing this Amendment No. 5 to Agreement No. 20-236 on the date stated in
the introductory clause.
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Provider(Individual): Jorge Romero
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Print Name:
JO4�9 A Xon&----e-z
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Title: 4771"
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Date:
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1 The parties are executing this Amendment No. 5 to Agreement No. 20-236 on the date stated in
the introductory clause.
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Provider(Individual): Michael Tucibat
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Print Name:
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Title:
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1 The parties are executing this Amendment No. 5 to Agreement No. 20-236 on the date stated in
the introductory clause.
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Provider(Individual): Ka Bao Vang
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Date: � Ii 24A
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1 The parties are executing this Amendment No. 5 to Agreement No. 20-236 on the date stated in
the introductory clause.
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Provider (Individual): Zoua Xiong
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By:
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Print Name. 9
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Title:
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1 The parties are executing this Amendment No. 5 to Agreement No. 20-236 on the date stated in
the introductory clause.
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Provider (individual): Eugene Yamamoto
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By:
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Print Name:
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Title:
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1 The parties are executing this Amendment No. 5 to Agreement No. 20-236 on the date stated in
the introductory clause.
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Provider (Group): A Hopeful Encounter
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By:
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Print Name: _Susan Xiong
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Title: President & CEO
9 Chairman of the board, or President, or any Vice president
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11 Date: 11/19/24
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18 Title:
Secretary (of Corporation), or any Assistant Secretary,
19 or Chief Financial Officer, or any Assistant Treasurer
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1 The parties are executing this Amendment No. 5 to Agreement No. 20-236 on the date stated in
the introductory clause.
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Provider (Group): Allay Psychological Services
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By
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Print Name: /2.�-Sh U L._W L47 LLAJ ,
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Title:
9 Chairman of the board, or President, or any ice president
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11 Date: 11b8z2 y,/
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13Aa�14 By /4-X
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16 Print Name: tz
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18 Title:
Secretary�rporation), or any Assisfant Secretary,
19 or Chief Financial Officer, or any Assistant Treasurer
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21 Date: j1/l f 7"=I
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1 The parties are executing this Amendment No. 5 to Agreement No. 20-236 on the date stated in
the introductory clause.
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Provider (Group): Bio Behavioral Medical Clinics
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gy �✓
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Print Name: Kenneth A. Steinbach, M.D.
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Title: Vice President
g Chairman of the board, or President, or any Vice president
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11 Date:
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16 Print Name: Monica Muro
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18 Title: Administrator & CFO
Secretary (of Corporation), or any Assistant Secretary.
19 or Chief Financial Officer, or any Assistant Treasurer
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21 Date: 11/18/2024
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1 The parties are executing this Amendment No. 5 to Agreement No. 20-236 on the date stated in
the introductory clause.
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Provider (Group): DN Associates
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By:
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6 Curtis Donovan
Print Name:
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8 Executive Director
Title:
9 Chairman of the board, or President, or any Vice president
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11/25/2024
11 Date:
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16 Print Name:
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18 Title:
Secretary (of Corporation), or any Assistant Secretary,
19 or Chief Financial Officer, or any Assistant Treasurer
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1 The parties are executing this Amendment No. 5 to Agreement No. 20-236 on the date stated in
the introductory clause.
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Provider (Group): Erene Soliman Psychologist INC.
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By:
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Print Name: l
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9 Chairman of the board, or President, or any Vice president
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11 Date: ✓ O
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14 By:
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16 Print Name: GU
17 .�18 Title:
Secretary( Corpor tion), or y A! ant Secretary,
19 or Chief Fi ncial O cer, or a y Assistant Treasurer
20 f1 nn
21 Date:
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1 The parties are executing this Amendment No. 5 to Agreement No. 20-236 on the date stated in
the introductory clause.
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Provider (Group): Esperanza Family Counseling
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By:
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Print Name: Sergio Pereyra, PhD, LMFT
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8 Title: CEO, President
9 Chairman of the board, or President, or any Vice president
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11 Date: 11/18/2024
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14 By:
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16 Print Name:
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18 Title:
Secretary (of Corporation), or any Assistant Secretary,
19 or Chief Financial Officer, or any Assistant Treasurer
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1 The parties are executing this Amendment No. 5 to Agreement No. 20-236 on the date stated in
the introductory clause.
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Provider (Group): Fresno American Indian Health Project
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By:
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Print Name: L VVL
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Title:
9 Chairman of-the board, or President, or any Vice presid nt
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11 Date: G1 l 2 1
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14 By:
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16 Print Name:
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18 Title:
Secretary (of Corporation), or any Assistant Secretary,
19 or Chief Financial Officer, or any Assistant Treasurer
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1 The parties are executing this Amendment No. 5 to Agreement No. 20-236 on the date stated in
the introductory clause.
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Provider (Group): Fresno New Connections
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By:
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Print Name.
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Title:
Ivy'64; �
g Chairman of the board, or President, or any Vice president
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11 Date: (l lg ZoZ
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14 By.
G C -
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16 l
Print Name:
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18 Title: SOs.'(-dv
Secretary tc,l ��,rp_;rati�r,�. ' any Assistant Secretary,
19 or Chief Financial Officer, or any Assistant Treasurer
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21 Date:
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1 The parties are executing this Amendment No. 5 to Agreement No. 20-236 on the date stated in
the introductory clause.
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Provider (Group): Generational Changes, Inc.
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By:
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Print Name: Dr Linda Scott
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Title: CEO
g Chairman of the board, or President, or any Vice president
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11 Date: 11/21/24
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14 By:
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16 Print Name: Anita Washington
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18 Title: Office Manager
Secretary (of Corporation), or any Assistant Secretary,
19 or Chief Financial Officer, or any Assistant Treasurer
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1 PROVIDER (GROUP):
2101
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By:
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5 Print Name: J
67.
,
Title: L��i�Cu y� �/��l1�C�j/y
7 Chairman of the Board, or
8 President, or any Vice President
9
10 Date:
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13 By:
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15 Print Name:
16
Title:
17 Secretary (of Corporation), or
any Assistant Secretary, or
18 Chief Financial Officer, or
19 any Assistant Treasurer
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Date:
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COUNTY OF FRESNO
Fresno, CA
1 The parties are executing this Amendment No. 5 to Agreement No. 20-236 on the date stated in
the introductory clause.
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Provider(Group): House Psychiatric Clinic, Inc.
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By:
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6 17R oJs e
Print Name.
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Title:
g Chairman of the board, or President, or any Vice president
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11 Date:
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14 By:
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16 Print Name:
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18 Title.-
Secretary (of Corporation), or any Assistant Secretary,
19 or Chief Financial Officer, or any Assistant Treasurer
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21 Date:
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1 The parties are executing this Amendment No. 5 to Agreement No. 20-236 on the date stated in
the introductory clause.
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Provider(Group): Impact Behavioral Health and Recovecy
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By:
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Print Name:
7
Tale:
g Chairman of the board, or President,or any Vice president
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11 Date:
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14 By.
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16 print Name: ICrGSA [�/Se
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18 Title: �f"Dr T r L Go P
Secretary(of Corporation), or any Assistant Secretary,
19 or Chief Financial Officer, or any Assistant Treasurer
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21 Date:
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1 The parties are executing this Amendment No. 5 to Agreement No. 20-236 on the date stated in
the introductory clause.
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Provider(Group)z- Inspire Psychological Services Inc.
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4 -
By:
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Print Name:
7
Title:
9 Chairman of the board, or resident, or any Vice president
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11 Date:
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14 By:
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16 Print Name:
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18 Title:
Secretary (of Corporation), or any Assistant Secretary,
19 or Chief Financial Officer, or any Assistant Treasurer
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21 Date:
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1 The parties are executing this Amendment No. 5 to Agreement No. 20-236 on the date stated in
the introductory clause.
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Provider (Group): Integral Community Solutions Institute
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By:
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Print Name: Tt < 13 0 /:2 C
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8
Title: `
g Chairman of the-board, or President, or any Vice president
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11 Date:
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14 By:
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16 Print Name: t !Y)
17 �-
18 Title:
Secretary(of Corporation), or any Assistant Secretary,
19 or Chief Financial Officer, or any Assistant Treasurer
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21 Date:
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1 The parties are executing this Amendment No. 5 to Agreement No. 20-236 on the date stated in
the introductory clause.
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Provider(Group): Joint Opportunities
3 �I ,
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By:
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Print Name: I
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Title:
9 Chairman of the board, or President, or any Vice president
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11 Date:
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14 By:
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16 Print Name:
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18 Title:
Secretary (of Corporation), or any Assistant Secretary,
19 or Chief Financial Officer, or any Assistant Treasurer
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21 Date:
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1 The parties are executing this Amendment No. 5 to Agreement No. 20-236 on the date stated in
the introductory clause.
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Provider(Group): Marjaree Mason Center
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By:
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s ff
Print Name:
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Title:
g Chairman of the board, or President, or any Vice president
10 j
11 Date: ar)
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14 By:
15 rn
16 I Print Name:
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18 Title:
Secretary(of Corporation), or any Assistant Secretary,
19 or Chief Financial Officer, or any Assistant Treasurer
20 l /
21 Date:
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1 The parties are executing this Amendment No. 5 to Agreement No. 20-236 on the date stated in
the introductory clause.
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Provider (Group): Omid Counseling Center, Inc.
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By:
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e Print Name: Rbh"I/Q14 rq L
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8 Title: l/l r amn
g Chairman of the board, or President, or any Vice president
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11 Date: q
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14 By: M ao
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16 Print Name: t4 A-V6 01� Orr e1Ala
Id
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18 Title: C o b
Secretary (of Corporation), or any Assistant Secretary,
19 or Chief Financial Officer, or any Assistant Treasurer
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21 Date:
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1 The parties are executing this Amendment No. 5 to Agreement No. 20-236 on the date stated in
the introductory clause.
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Provider(Group): Poverello House Enrichment Center
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4 By:
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Print Name:
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8 Title: C t✓ �t�" � �—
g Chairman of the board, or President, or any Vice president
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11 Date:
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14 By:
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16 Print Name:
17
18 Title:
Secretary (of Corporation), or any Assistant Secretary,
19 or Chief Financial Officer, or any Assistant Treasurer
20
21 Date:
22
23
24
25
26
27
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42
1 The parties are executing this Amendment No. 5 to Agreement No. 20-236 on the date stated in
the introductory clause.
2
Provider (Group): Precision Psychiatric Services, Inc.
3
4
By: f (L R��
5 Ldf
6 Mint Dillon
Print Name: y
7
8
Title: CEO
9 Chairman of the board, or President, or any Vice president
10
11 Date: 11/22/24
12
13
14 By:
15
16 Print Name:
17
18 Title:
Secretary (of Corporation), or any Assistant Secretary,
19 or Chief Financial Officer, or any Assistant Treasurer
20
21 Date:
22
23
24
25
26
27
28
43
1 The parties are executing this Amendment No. 5 to Agreement No. 20-236 on the date stated in
the introductory clause.
2
Provider(Group): _ Prodigy Healthcare I.nc.
3
4
By: r/
5
6
Print Name: �ck-'k IRv rate
7
8 /
Title: gesidle,?
g Chairman of the board, or President, or any Vice president
10
11 Date: 1111f 2Y
12
13
14 By:
15
16 print Name: .
17
18 Title: C -J
Secretary (of Corporation), or any Assistant Secretary,
19 or Chief Financial Officer, or any Assistant Treasurer
20
21 Date: _ it 1'0-ZZ
22
23
24
25
26
27
28
44
1 The parties are executing this Amendment No. 5 to Agreement No. 20-236 on the date stated in
the introductory clause.
2
Provider(Group): Promesa Behavioral Health
3
4
By:
5
Print Name: -C�-
7
8
Title:
g Chairman of the board, or President, or any Vice president
10
11 Date:
12
13
14 By.
15
16 Print Name: Z Viy ►U A,
17 r
18 Title: C- r co
Secretary(of Corporation), or any Assistant Secretary,
19 or Chief Financial Officer, or any Assistant Treasurer
20
21 Date:
22
23
24
25
26
27
28
45
I
Docusign Envelope ID:9387A7BC-5890-4CC1-A8DC-BADE9C293520
1 The parties are executing this Amendment No. 5 to Agreement No. 20-236 on the date stated in
the introductory clause.
2
Provider (Group): Quality Group Homes, Inc
3
DocuSgned-bY
4 R c l ey
By:
5
6 .James Clark
Print Name:
7
8
Title: President
9 Chairman of the board, or President, or any Vice president
10
11 Date: 11/20/2024
12
13
Signed by:
14 By: sign,d by:
t, M.a{�.is
CAZFEFS6C3�'33
15
Catherine Mathis
16 Print Name:
17
18 Title: secretary
Secretary (of Corporation), or any Assistant Secretary,
19 or Chief Financial Officer, or any Assistant Treasurer
20
21 Date: 11/22/2024
22
23
24
25
26
27
28
46
1 The parties are executing this Amendment No. 5 to Agreement No. 20-236 on the date stated in
the introductory clause.
2
Provider(Group): Resiliency Center of Fresno
3
4 � �
By: -
5
Print Name: %i✓ / / / cZez-1//2e-
7
Title: 1U�"'�
9 Chairman of the board, or President, or any Vice president
10 'J
11 Date:
12
13
14 I -
15
16 Print Name:
17
18 Title:
Secretary (of Corporation), or any Assistant Secretary,
19 or Chief Financial Officer, or any Assistant Treasurer
20
21 Date:
22
23
24
25
26
27
28
47
1 The parties are executing this Amendment No. 5 to Agreement No. 20-236 on the date stated in
the introductory clause.
2
Provider(Group): Ron Steele and Associates Inc.
3
4
By:
5
6
Print Name: /
7
8
Title: t`U !`
9 Chairman of the board, or President, or any Vice president
10
11 Date: �1 1
12
13
14 By:
15
16 Print Name:
17
18 Title:
Secretary (of Corporation), or any Assistant Secretary,
19 or Chief Financial Officer, or any Assistant Treasurer
20
21 Date:
22
23
24
25
26
27
28
48
1
2
3
4
5
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7
8
9
10
11 This page is intentionally left blank.
12
13
14
15
16
17
18
19
20
21
22
23
24
25
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49
1 The parties are executing this Amendment No. 5 to Agreement No. 20-236 on the date stated in
the introductory clause.
2
Provider(Group): SJET Clinical Services
3
4
By:
5
6
Print Name: �v �'1 r✓��
7
8
Title: AA C LS A
g Chairman oft the board, or President, or any Vice president
10
11 Date:
12
13
14 By.
15
16 Print Name:
17
18 Title:
Secretary(of Corporation), or any Assistant Secretary,
19 or Chief Financial Officer, or any Assistant Treasurer
20
21 Date:
22
23
24
25
26
27
28
50
1 The parties are executing this Amendment No. 5 to Agreement No. 20-236 on the date stated in
the introductory clause.
2
Provider(Group): The Healing Circle: A Marriage & Family Therapy Professional
3 Corporation
4
5 By:
6
7 Print Name: / kz4r--tl�I�
8 c ' r
9 Title:
Chairman of the board, or President, or any Vice president
10
11 Date: ( �
12
13
14
15 By.
16
Print Name:
17
18
Title:
19 Secretary (of Corporation), or any Assistant Secretary,
or Chief Financial Officer, or any Assistant Treasurer
20
21
Date:
22
23
24
25
26
27
28
51
I
Docusign Envelope ID:79CFODA6-1BCC-49A8-897E-04DA59566541
1 The parties are executing this Amendment No. 5 to Agreement No. 20-236 on the date stated in
the introductory clause.
2
Provider (Group): Valley Children's Hospital
3
DocuSigned by:
4
By: _ fi �(ref`
5 873951 DOOF26420...
6 Print Name: Tina Mycroft
7
8 Title: SVP and CFO
9 Chairman of the board, or President, or any Vice president
10
11/20/2024 1 09:53:01 PST
11 Date:
12
13
14 By:
15
16 Print Name:
17
18 Title:
Secretary (of Corporation), or any Assistant Secretary,
19 or Chief Financial Officer, or any Assistant Treasurer
20
21 Date:
22
23
24
25
26
27
28
52
1 The parties are executing this Amendment No. 5 to Agreement No. 20-236 on the date stated in
the introductory clause.
2
Provider(Group): West Side Church of God
3
4
By:
5
6 Print Name: Arnesia Williams
7
8
Title: Vice-Chairman of the board
9 Chairman of the board, or President, or any Vice president
10
11 Date:
11/21/24
12
13
14 By:
15
16 Print Name:
17
18 Title:
Secretary (of Corporation), or any Assistant Secretary,
19 or Chief Financial Officer, or any Assistant Treasurer
20
21 Date:
22
23
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Page 1 of 3
Revised Exhibit A-4
Individual Providers
Name Address Email
Amato, Dolores 6777 N. Willow Ave Fresno, CA 93710 dgamato@gmail.com
Baca, Karina 5070 N. Sixth Street Suite 105, Fresno, CA karicbm22@gmail.com
93710
Cooke,Johanna V. 5100 N. 6th St Fresno, CA 93710, Ste 151 jcooke.lcsw@gmail.com
Dickey, Judith 501 E. Terrace Ave Fresno CA 93704 jstoryteller1 @icloud.com
Farris, Donald 3740 Circle Dr. Fresno, CA 93704-4765 donfarris1871@gmail.com
Jones, Kimberly M. 5665 S. Chestnut Ave Spc 61 Fresno, CA drkimjones02@gmail.com
93725
La Familia Therapy
Services, Inc. 4229 E. Clinton, Fresno, CA 93703 lafamiliatherapyservices@gmail.com
Lynch, Nasim Nancy 5151 N. Palm Ave#950, Fresno, CA 93704 nancylynch24@hotmail.com
McClincy, Erica 1100 W. Shaw Ave Suite 120 Fresno, CA EricaMcClincy.LCSW@gmail.com
93711
Nalls, Kannon E. 739 Meadow Ct., Exeter, CA 93221 drkannonnalls@gmail.com
5588 N. Palm Ave, Fresno CA 93704
1445 Marion St Kingsburg, CA 93631
Quintanilla, Elsa 5588 N. Palm Ave Fresno, CA 93704 quintanillac12@gmail.com
Quintanilla, Juan 5588 N. Palm Ave Fresno, CA 93704 archaicvegan@outlook.com
Randolph, Michelle 438 E. Shaw Ave#140 Fresno, CA 93710 michelleneufer(cDgmail.com
5070 N. 6th Street Suite 105, Fresno, CA 93710
Roltgen, Teresa 2505 W. Shaw Ave Fresno, CA 93711 teriroltgen@gmail.com
Romero, Jorge 373 E. Shaw Ave# 140, Fresno, CA 93710 ajorgeandrom@aol.com
Tucibat, Michael 6777 N.Willow Ave, Suite# 142 Fresno, CA Mike.Tucibat.LMFT@infinitewebs.net
93710
5070 N. Sixth Street Suite 105, Fresno, CA
Vang, Ka Bao 93710 kbadame02@gmail.com
Xiong,Zoua 5588 N. Palm Ave Fresno, CA 93704 zouaxiongmft@gmail.com
Yamamoto, Eugene 5151 N. Palm Ave Suite 500 Fresno, CA 93704 Yamfamily2@gmail.com
Page 2 of 3
Revised Exhibit A-4
Group Providers
Name Address Email
A Hopeful Encounter 3253 E. Shields Ave Fresno, CA 93726 susanxionq(a�hopefulencounter.org
Allay Psychological Services 2900 Fresno St.#108, Fresno, CA 93721 reshale@allaypsych.com
Bio Behavioral Medical Clinics 1060 W.Sierra Ave, Suite 105, Fresno, CA mmuro@bbmc-inc.com
93711
DN Associates 4460 W. Shaw Ave#595, Fresno, CA 93722 cdonovan@coreconditions.org
Erene Soliman Psychologist INC. 5151 N. Palm Ave#500, Fresno, CA 93704 esoliman@att.net
575 E. Locust Ave STE 101, Fresno, CA
Esperanza Family Counseling 93720 sergiop.esperanzafc@gmail.com
Fresno American Indian Health 1551 E. Shaw Ave.#139, Fresno, CA 93710 bramirez@faihp.org
Project
Fresno New Connections 4411 N. Cedar Ave, Fresno, CA 93726 rmartin@teamfnc.com
Generational Changes, Inc. 2409 Merced St Ste 106 Fresno, CA 93721 gchanges.inc@gmail.com
Healing Hope, Inc. 1913 N.Gateway Blvd#101, Fresno, CA morxpopper@healinghopeinc.org
93727
1322 E. Shaw Ave Suite 410, Fresno, CA
House Psychiatric Clinic, Inc. 93710 staff@houseclinic.org
Impact Behavioral Health and
Recovery 1616 W. Shaw Ave BLD B2 Fresno CA, impactbhrc@gmail.com
93711
Inspire Psychological Services, 5807 E. Beck Ave, Fresno, CA 93727 chengvang2004@gmail.com
Inc.
Integral Community Solutions 1065 S St Building 1, Fresno, CA 93721 jcgarcia@icsi.solutions
Institute
Joint Opportunities 1424 W. California Ave, Fresno, CA 93706 mickievalentine@icloud.com
Marjaree Mason Center 1600 M Street, Fresno, CA 93721 laurae@mmcenter.org
3451 W.Shaw Ave Ste 102, Fresno CA
Omid Counseling Center, Inc. 93711 Omidhopecenter@gmail.com
Poverello House Enrichment 412 F St Fresno, CA 93706 kmurphy@poverellohouse.org
Center
Precision Psychiatric 7850 White Lane, Suite E301, Bakersfield, CAO(a).precisionpsych.com
Services, Inc. CA 93309 minty(a-)precision Psych.com
bodoh(a-)precision psych.com
Page 3 of 3
Revised Exhibit A-4
Prodigy Healthcare Inc. 311 E. Merced St., Fowler CA, 93625 harjas@prodigy-hc.com; d@prodigy-
hc.com
JRomero@promesabehavioral.org;
Imcclain@promesabehavioral.org;
Promesa Behavioral Health 7120 N. Marks Ave, Fresno, CA 93711 Iweigant@promesabehavioral.org;ezuniga@promesabehavioral.org
valeriec@qualityfamilyservices.org;
4946 E.Yale Ave, Suite 103, Fresno, CA sarah@qualityfamilyservices.org;
Quality Group Homes, Inc. 93727 lisac@qualityfamilyservices.org;
duked@qualityfamilyservices.org
referral@fresnorc.org;
Resiliency Center of Fresno 3845 N. Clark St Ste 201 Fresno, CA 93726 parrot@fresnorc.org;
riowrey@fresnorrc.org
roncsteele1 @gmail.com
Ron Steele and Associates Inc 5150 N. 6th St STE 169, Fresno, CA 93710
soymejica@verizon.net
SJET Clinical Services 418 N. 6th Street, Fowler, CA 93625
Gmadriga180(@-gmail.com
The Healing Circle:A Marriage& 1033 N. Fulton St, Fresno, CA 93728
Family Therapy Professional
Corporation
MDanovsky(@valleychildrens.org
Valley Children's Hospital 9300 Valley Children's Place, Madera, CA
93636
mickievalentine@icloud.com
West Side Church of God 1424 W. California Ave, Fresno, CA 93706