Basic Information
| Provider Information | |||||||||
| NPI: | 1346402336 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PRADO | ||||||||
| FirstName: | NOE | ||||||||
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| Credential: | MFTI | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1107 | ||||||||
| Address2: | |||||||||
| City: | CLOVIS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936131107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592560100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4910 E ASHLAN AVE | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937263020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592560100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2008 | ||||||||
| LastUpdateDate: | 12/01/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 87120 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.