Healthcare Provider Details

I. General information

NPI: 1912170911
Provider Name (Legal Business Name): CONSTANCE M TREIS MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2008
Last Update Date: 04/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 N CHINAWTH ST
VISALIA CA
93291-7896
US

IV. Provider business mailing address

1124 N CHINAWTH ST
VISALIA CA
93291-7896
US

V. Phone/Fax

Practice location:
  • Phone: 559-635-4252
  • Fax: 559-635-4281
Mailing address:
  • Phone: 559-635-4252
  • Fax: 559-635-4281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMFC24170
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: