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General NPI Number Information
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NPI Number | 1225686769
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Entity Type | Individual
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Provider Name | ELIZABETH IAQUINTO LMFT
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Gender | Female
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Dates
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Enumeration Date | 08/28/2019
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Last Update Date | 12/19/2024
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Provider Practice Location Address
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Address Line | 420 BULLARD AVE STE E
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City | CLOVIS
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State | CA
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Zip | 93612-1054
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Country | US
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Telephone | 559-679-9220
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Fax |
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Provider Business Mailing Address
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Address Line | 5333 N SANTA FE AVE
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City | FRESNO
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State | CA
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Zip | 93711-2639
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Country | US
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Telephone | 559-679-9220
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT149510
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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