Healthcare Provider Details

I. General information

NPI: 1194541987
Provider Name (Legal Business Name): MCDERMOTT INDIVIDUAL AND FAMILY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2024
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 W CENTER AVE
VISALIA CA
93291-5911
US

IV. Provider business mailing address

1220 W CENTER AVE
VISALIA CA
93291-5911
US

V. Phone/Fax

Practice location:
  • Phone: 559-280-5756
  • Fax:
Mailing address:
  • Phone: 559-280-5756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: RACHEL SARAH MCDERMOTT
Title or Position: OWNER
Credential: LMFT
Phone: 559-786-3435