Healthcare Provider Details

I. General information

NPI: 1508380460
Provider Name (Legal Business Name): JOANNE LAI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 04/16/2021
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7766 N PALM AVE STE 107
FRESNO CA
93711-5734
US

IV. Provider business mailing address

1122 S ST STE 102
FRESNO CA
93721-1430
US

V. Phone/Fax

Practice location:
  • Phone: 559-435-0800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4133
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT121155
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: