Healthcare Provider Details

I. General information

NPI: 1487010419
Provider Name (Legal Business Name): PA KOU VUE LMFT #121352
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2016
Last Update Date: 01/02/2022
Certification Date: 01/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 E. SHAW AVE, SUITE #116
FRESNO CA
93710-8007
US

IV. Provider business mailing address

711 W. SHAW AVE. #112, PMB 71
CLOVIS CA
93612-3214
US

V. Phone/Fax

Practice location:
  • Phone: 559-202-3390
  • Fax: 559-468-0288
Mailing address:
  • Phone: 559-668-1736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number121352
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: