Healthcare Provider Details

I. General information

NPI: 1295278117
Provider Name (Legal Business Name): KATHY A STEELE, LCSW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2016
Last Update Date: 11/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3114 WILLOW AVE 102
CLOVIS CA
93612-4750
US

IV. Provider business mailing address

179 ANDERSON AVE
CLOVIS CA
93612-5720
US

V. Phone/Fax

Practice location:
  • Phone: 559-223-0177
  • Fax:
Mailing address:
  • Phone: 559-223-0177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW21376
License Number StateCA

VIII. Authorized Official

Name: KATHY ANN STEELE
Title or Position: LICENSED CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 559-223-0177