Healthcare Provider Details

I. General information

NPI: 1104346253
Provider Name (Legal Business Name): ELENA CUEVAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2017
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2540 W SHAW LANE SUITE 110
FRESNO CA
93711-2281
US

IV. Provider business mailing address

2540 W SHAW LN STE 110
FRESNO CA
93711-2700
US

V. Phone/Fax

Practice location:
  • Phone: 559-443-4800
  • Fax:
Mailing address:
  • Phone: 559-443-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number119744
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number150792
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: