Healthcare Provider Details

I. General information

NPI: 1073448155
Provider Name (Legal Business Name): MARK EUGENE LADD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 N PARKWAY DR # 122
FRESNO CA
93728-2724
US

IV. Provider business mailing address

933 N PARKWAY DR # 122
FRESNO CA
93728-2724
US

V. Phone/Fax

Practice location:
  • Phone: 559-218-1906
  • Fax:
Mailing address:
  • Phone: 559-218-1906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: