Basic Information
Provider Information | |||||||||
NPI: | 1356795587 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ALEJANDRO | ||||||||
FirstName: | CHEREE | ||||||||
MiddleName: | MELISSA | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | LPCC 10092 | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3621 GRIFFITH AVE | ||||||||
Address2: |   | ||||||||
City: | CLOVIS | ||||||||
State: | CA | ||||||||
PostalCode: | 936197271 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5595404789 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 2772 S MARTIN LUTHER KING BLVD | ||||||||
Address2: |   | ||||||||
City: | FRESNO | ||||||||
State: | CA | ||||||||
PostalCode: | 93706 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5592654800 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/13/2016 | ||||||||
LastUpdateDate: | 10/15/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 10/15/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 2280 | CA | N |   | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | PCCI2280 | CA | N |   | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | APCC2280 | CA | N |   | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | LPCC10092 | CA | N |   | Behavioral Health & Social Service Providers | Counselor | Professional | 101YM0800X | LPCC10092 | CA | Y |   | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.