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General NPI Number Information
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NPI Number | 1679792386
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Entity Type | Individual
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Provider Name | JONELL COX DUSTIN LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 1425 N RABE AVE 101
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City | FRESNO
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State | CA
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Zip | 93727-2117
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Country | US
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Telephone | 559-255-1446
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Fax | 559-255-4876
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Provider Business Mailing Address
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Address Line | 474 S CLOVIS AVE #102
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City | FRESNO
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State | CA
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Zip | 93727-4247
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Country | US
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Telephone |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS16685
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License Number State | CA
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