Healthcare Provider Details

I. General information

NPI: 1871869669
Provider Name (Legal Business Name): GRACE ANN MAHONEY LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2012
Last Update Date: 09/26/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4447 E. CESAR CHAVEZ BLVD
FRESNO CA
93702-4804
US

IV. Provider business mailing address

6094 N PLEASANT AVE
FRESNO CA
93711-2267
US

V. Phone/Fax

Practice location:
  • Phone: 559-600-0646
  • Fax: 559-600-9135
Mailing address:
  • Phone: 559-905-9521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number69402
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number97366
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: