Healthcare Provider Details

I. General information

NPI: 1912514522
Provider Name (Legal Business Name): BRIANDA CECILIA LEMUS ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 04/01/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 MCCALL AVE STE 104
SELMA CA
93662-2560
US

IV. Provider business mailing address

3400 MCCALL AVE STE 104
SELMA CA
93662-2560
US

V. Phone/Fax

Practice location:
  • Phone: 559-436-0482
  • Fax:
Mailing address:
  • Phone: 559-436-0482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number96490
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: