Healthcare Provider Details

I. General information

NPI: 1386361608
Provider Name (Legal Business Name): JENNIFER JANE CISNEROS LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2022
Last Update Date: 10/26/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7257 N MAPLE AVE STE 106
FRESNO CA
93720-0167
US

IV. Provider business mailing address

12566 S WILLOW AVE
FRESNO CA
93725-9127
US

V. Phone/Fax

Practice location:
  • Phone: 559-440-6074
  • Fax:
Mailing address:
  • Phone: 559-313-0771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number130873
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: