Healthcare Provider Details

I. General information

NPI: 1144464066
Provider Name (Legal Business Name): ISABEL MEJORADO M.S., LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2009
Last Update Date: 03/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1357 W SHAW AVE STE 106
FRESNO CA
93711-3619
US

IV. Provider business mailing address

1357 W SHAW AVE STE 106
FRESNO CA
93711-3619
US

V. Phone/Fax

Practice location:
  • Phone: 559-492-2428
  • Fax: 559-492-2537
Mailing address:
  • Phone: 559-492-2428
  • Fax: 559-492-2537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 47104
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: