Healthcare Provider Details

I. General information

NPI: 1306227947
Provider Name (Legal Business Name): INNOVATIONS COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2015
Last Update Date: 06/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 WST. WINERY AVE 101
FRESNO CA
93703
US

IV. Provider business mailing address

2100 W. WINERY AVE #101
FRESNO CA
93703
US

V. Phone/Fax

Practice location:
  • Phone: 323-326-0860
  • Fax:
Mailing address:
  • Phone: 323-326-0860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number StateCA

VIII. Authorized Official

Name: MRS. DIANE CAROL MCNEAL
Title or Position: CEO/DIRECTOR
Credential: MAMFT
Phone: 323-326-0860