Healthcare Provider Details

I. General information

NPI: 1013576081
Provider Name (Legal Business Name): ANTHONY GRACIAN ASW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1393 BAILEY ST
HANFORD CA
93230-5922
US

IV. Provider business mailing address

1393 BAILEY ST
HANFORD CA
93230-5922
US

V. Phone/Fax

Practice location:
  • Phone: 559-582-4481
  • Fax:
Mailing address:
  • Phone: 559-582-4481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number136802
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberASW84573
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: