Healthcare Provider Details

I. General information

NPI: 1548706971
Provider Name (Legal Business Name): VANESSA TERCERO M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VANESSA BETHANY AVILES M.A.

II. Dates (important events)

Enumeration Date: 01/09/2017
Last Update Date: 09/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 S CENTRAL ST
VISALIA CA
93277-4418
US

IV. Provider business mailing address

PO BOX 5091
VISALIA CA
93278-5091
US

V. Phone/Fax

Practice location:
  • Phone: 559-730-2969
  • Fax:
Mailing address:
  • Phone: 559-747-0115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: