Healthcare Provider Details

I. General information

NPI: 1912056821
Provider Name (Legal Business Name): CAROL ANN YODER MFT INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1734 W SHAW AVE
FRESNO CA
93711-3416
US

IV. Provider business mailing address

5884 E PROVINCE AVE
CLOVIS CA
93619-7806
US

V. Phone/Fax

Practice location:
  • Phone: 559-439-2647
  • Fax: 559-439-2214
Mailing address:
  • Phone: 559-696-6978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF 51230
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: