MEDICARE: MARYLOU ESCOTO M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	LMFT112382	CA
2	106H00000X	Marriage & Family Therapist	112382	CA

General Provider Information

NPI Number	:	1588839468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYLOU ESCOTO M.S.

Provider Business Mailing Address
First Line	:	142 E CALIFORNIA AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93706-3642
Country	:	US
Telephone Number	:	559-600-1042
Fax Number	:	559-600-1101

Provider Business Practice Location Address
First Line	:	142 E CALIFORNIA AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93706-3642
Country	:	US
Telephone Number	:	559-600-1042
Fax Number	:	559-600-1101

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2008
Last Update Date	:	06/18/2019

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