Healthcare Provider Details

I. General information

NPI: 1457865438
Provider Name (Legal Business Name): JULIETTE PASCUA MAMUAD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2017
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

THE KIND CENTER 1222 WEST LACEY BLVD. CENTER
HANFORD CA
93230
US

IV. Provider business mailing address

CENTRAL STAR BEHAVIORAL HEALTH GROUP 3433 W SHAW AVE STE 102
FRESNO CA
93711-3229
US

V. Phone/Fax

Practice location:
  • Phone: 559-235-9239
  • Fax:
Mailing address:
  • Phone: 559-558-4051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPCC6518
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number157110
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: