MEDICARE: THERESA DE LEON OROSCO LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	106H00000X	Marriage & Family Therapist	138861	CA

General Provider Information

NPI Number	:	1093123291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA DE LEON OROSCO LMFT

Provider Business Mailing Address
First Line	:	1060 W STUART AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93711-2037
Country	:	US
Telephone Number	:	559-301-3808
Fax Number	:

Provider Business Practice Location Address
First Line	:	1060 W STUART AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93711-2037
Country	:	US
Telephone Number	:	559-301-3808
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2014
Last Update Date	:	04/20/2024

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