Basic Information
| Provider Information | |||||||||
| NPI: | 1821454950 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAMIREZ | ||||||||
| FirstName: | TERRY | ||||||||
| MiddleName: | M | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3097 WILLOW AVE STE 9 | ||||||||
| Address2: | |||||||||
| City: | CLOVIS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936124715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592707940 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1225 M ST | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596009300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2016 | ||||||||
| LastUpdateDate: | 07/30/2018 | ||||||||
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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 | 106H00000X | 50485 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.