Healthcare Provider Details

I. General information

NPI: 1518342849
Provider Name (Legal Business Name): THE BASHFUL ELEPHANT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2015
Last Update Date: 07/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3097 WILLOW AVE STE 4
CLOVIS CA
93612-4715
US

IV. Provider business mailing address

3097 WILLOW AVE STE 4
CLOVIS CA
93612-4715
US

V. Phone/Fax

Practice location:
  • Phone: 559-326-8391
  • Fax:
Mailing address:
  • Phone: 559-326-8391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMFC50672
License Number StateCA

VIII. Authorized Official

Name: F PATRICIA BUFFALOE
Title or Position: MANAGER
Credential: LMFT
Phone: 559-326-8391