Basic Information
| Provider Information | |||||||||
| NPI: | 1194868695 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AMANCIO | ||||||||
| FirstName: | ISABEL | ||||||||
| MiddleName: | CHRISTINA | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 108 | ||||||||
| Address2: | |||||||||
| City: | VISALIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932790108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5597349565 | ||||||||
| FaxNumber: | 5597349565 | ||||||||
| Practice Location | |||||||||
| Address1: | 4205 W. FIGARDEN DR. | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592211680 | ||||||||
| FaxNumber: | 5592214336 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2007 | ||||||||
| LastUpdateDate: | 09/24/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFC 39580 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.