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General NPI Number Information
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NPI Number | 1578721197
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Entity Type | Organization
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Legal Business Name | MEW FOUNDATION INC
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Dates
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Enumeration Date | 05/30/2008
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Last Update Date | 05/30/2008
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Provider Practice Location Address
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Address Line | 2560 W SHAW LN SUITE 105
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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 | 559-431-9995
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Fax | 559-431-9996
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Provider Business Mailing Address
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Address Line | 27332 PERKINS RD
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City | MADERA
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State | CA
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Zip | 93637-6117
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Country | US
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Telephone | 559-431-9995
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Fax | 559-431-9996
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Authorized Official
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Title or Position | CFO
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Name | MS. SUELLEN WISEMAN
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Credential | MBA
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Telephone | 559-431-9995
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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 | MCF19369
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License Number State | CA
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