Healthcare Provider Details

I. General information

NPI: 1063398808
Provider Name (Legal Business Name): KAYLA ANN ESCOBAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2025
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4676 N FARRIS AVE
FRESNO CA
93704-2902
US

IV. Provider business mailing address

7575 N CEDAR AVE STE 102
FRESNO CA
93720-2693
US

V. Phone/Fax

Practice location:
  • Phone: 209-675-4032
  • Fax:
Mailing address:
  • Phone: 559-321-2322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW131111
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: