Healthcare Provider Details

I. General information

NPI: 1730105479
Provider Name (Legal Business Name): NORTH STAR COUNSELING A LICENSED CLINICAL SOCIAL WORKER CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 04/04/2022
Certification Date: 04/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 WOODWORTH AVE
CLOVIS CA
93612-1847
US

IV. Provider business mailing address

624 WOODWORTH AVE
CLOVIS CA
93612-1847
US

V. Phone/Fax

Practice location:
  • Phone: 559-297-6060
  • Fax: 559-297-6061
Mailing address:
  • Phone: 559-297-6060
  • Fax: 559-297-6061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS14876
License Number StateCA

VIII. Authorized Official

Name: MARK B MCOMBER
Title or Position: PRESIDENT
Credential: LCSW
Phone: 559-297-6060