Healthcare Provider Details

I. General information

NPI: 1750019832
Provider Name (Legal Business Name): MISTY BLUE FRANCO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2022
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3676 E SHIELDS AVE
FRESNO CA
93726-6922
US

IV. Provider business mailing address

3676 E SHIELDS AVE
FRESNO CA
93726-6922
US

V. Phone/Fax

Practice location:
  • Phone: 559-400-3770
  • Fax:
Mailing address:
  • Phone: 559-400-3770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number138928
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: