Healthcare Provider Details

I. General information

NPI: 1578721197
Provider Name (Legal Business Name): MEW FOUNDATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 05/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2560 W SHAW LN SUITE 105
FRESNO CA
93711-2777
US

IV. Provider business mailing address

27332 PERKINS RD
MADERA CA
93637-6117
US

V. Phone/Fax

Practice location:
  • Phone: 559-431-9995
  • Fax: 559-431-9996
Mailing address:
  • Phone: 559-431-9995
  • Fax: 559-431-9996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMCF19369
License Number StateCA

VIII. Authorized Official

Name: MS. SUELLEN WISEMAN
Title or Position: CFO
Credential: MBA
Phone: 559-431-9995