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General NPI Number Information
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NPI Number | 1639772429
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Entity Type | Individual
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Provider Name | KATHLEEN GAO PHOUA VANG M.S., LMFT
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Gender | Female
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Dates
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Enumeration Date | 11/16/2020
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Last Update Date | 03/30/2023
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Provider Practice Location Address
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Address Line | 718 E MINARETS AVE
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City | FRESNO
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State | CA
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Zip | 93720-3010
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Country | US
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Telephone | 559-447-1114
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Fax |
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Provider Business Mailing Address
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Address Line | 7120 N MARKS AVE
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City | FRESNO
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State | CA
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Zip | 93711-0268
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Country | US
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Telephone | 559-439-5437
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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 | 122406
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 138881
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License Number State | CA
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