Basic Information
| Provider Information | |||||||||
| NPI: | 1275878530 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOUAVANGSOU | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | CHOUA | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4460 W SHAW AVE | ||||||||
| Address2: | PMB #128 | ||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937226210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8553431057 | ||||||||
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| Practice Location | |||||||||
| Address1: | 40 E MINARETS AVE | ||||||||
| Address2: | |||||||||
| City: | PINEDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936501239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8553431057 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/27/2012 | ||||||||
| LastUpdateDate: | 05/15/2014 | ||||||||
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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 | 69725 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.