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General NPI Number Information
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NPI Number | 1013339985
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Entity Type | Individual
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Provider Name | MITCHEL CORY CASADOS PH. D.
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Gender | Male
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Dates
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Enumeration Date | 01/13/2014
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Last Update Date | 12/26/2024
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Provider Practice Location Address
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Address Line | 4862 E CLINTON AVE
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City | FRESNO
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State | CA
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Zip | 93703-2873
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Country | US
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Telephone | 559-252-2450
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Fax |
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Provider Business Mailing Address
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Address Line | 3433 W SHAW AVE STE 108
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City | FRESNO
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State | CA
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Zip | 93711-3229
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Country | US
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Telephone | 559-813-0461
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 29898
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License Number State | CA
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