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General NPI Number Information
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NPI Number | 1528190402
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Entity Type | Organization
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Legal Business Name | FRESNO YOUTH ADVOCATES
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Dates
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Enumeration Date | 03/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2560 W SHAW LN SUITE 101
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City | FRESNO
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State | CA
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Zip | 93711-2777
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Country | US
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Telephone | 559-431-0580
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Fax |
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Provider Business Mailing Address
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Address Line | 2560 W SHAW LN SUITE 101
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City | FRESNO
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State | CA
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Zip | 93711-2777
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Country | US
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Telephone | 559-431-0580
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | MR. MYRON KEITH DOWNING
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Credential | LMFT 19396
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Telephone | 559-431-0500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State | CA
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