Healthcare Provider Details

I. General information

NPI: 1144043258
Provider Name (Legal Business Name): GURPREET BRAR-MACKIE LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

4785 N 1ST ST
FRESNO CA
93726-0513
US

IV. Provider business mailing address

1122 E OAKMONT AVE
FRESNO CA
93730-5926
US

V. Phone/Fax

Practice location:
  • Phone: 559-448-4555
  • Fax:
Mailing address:
  • Phone: 559-974-8661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMFT126423
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: