Healthcare Provider Details

I. General information

NPI: 1023282449
Provider Name (Legal Business Name): ROUBICEK & THACKER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1879 E FIR AVE SUITE 103
FRESNO CA
93720-3861
US

IV. Provider business mailing address

1879 E FIR AVE SUITE 103
FRESNO CA
93720-3861
US

V. Phone/Fax

Practice location:
  • Phone: 559-323-8484
  • Fax: 559-323-8686
Mailing address:
  • Phone: 559-323-8484
  • Fax: 559-323-8686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. MICHAEL C ROUBICEK
Title or Position: OWNER
Credential: LCSW
Phone: 559-323-8484