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General NPI Number Information
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NPI Number | 1518342849
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Entity Type | Organization
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Legal Business Name | THE BASHFUL ELEPHANT
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Dates
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Enumeration Date | 07/28/2015
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Last Update Date | 07/28/2015
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Provider Practice Location Address
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Address Line | 3097 WILLOW AVE STE 4
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City | CLOVIS
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State | CA
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Zip | 93612-4715
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Country | US
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Telephone | 559-326-8391
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Fax |
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Provider Business Mailing Address
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Address Line | 3097 WILLOW AVE STE 4
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City | CLOVIS
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State | CA
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Zip | 93612-4715
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Country | US
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Telephone | 559-326-8391
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | F PATRICIA BUFFALOE
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Credential | LMFT
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Telephone | 559-326-8391
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MFC50672
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License Number State | CA
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