Healthcare Provider Details

I. General information

NPI: 1811808090
Provider Name (Legal Business Name): ELIZABETH MCCLURG
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 S 10TH ST
FRESNO CA
93702-3505
US

IV. Provider business mailing address

720 S 10TH ST
FRESNO CA
93702-3505
US

V. Phone/Fax

Practice location:
  • Phone: 559-253-5390
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: