Basic Information
| Provider Information | |||||||||
| NPI: | 1205370400 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ORNELAS | ||||||||
| FirstName: | MIGUEL | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1945 N FINE AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937271528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594575650 | ||||||||
| FaxNumber: | 5594575695 | ||||||||
| Practice Location | |||||||||
| Address1: | PSYCHIATRIC HEALTH FACILITY | ||||||||
| Address2: | 4411 E. KINGS CANYON RD #319 | ||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937029370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596002382 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2016 | ||||||||
| LastUpdateDate: | 02/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LCSW92405 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.