Basic Information
| Provider Information | |||||||||
| NPI: | 1568750131 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FLETCHER | ||||||||
| FirstName: | JO ELLEN | ||||||||
| MiddleName: | S. | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5014 CHESEBRO RD. | ||||||||
| Address2: | FIRST FLOOR | ||||||||
| City: | AGOURA HILL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8053676080 | ||||||||
| FaxNumber: | 8188965069 | ||||||||
| Practice Location | |||||||||
| Address1: | 5014 CHESEBRO RD. | ||||||||
| Address2: | FIRST FLOOR | ||||||||
| City: | AGOURA HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8053676080 | ||||||||
| FaxNumber: | 8188965069 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2011 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 106H00000X | LMFT85238 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | 7068 | 05 | CA | MEDICAID |