Basic Information
| Provider Information | |||||||||
| NPI: | 1457722712 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MUKAFU | ||||||||
| FirstName: | JANAELYN | ||||||||
| MiddleName: | MITCHELL | ||||||||
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| Credential: | AMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2803 ALMOND AVE | ||||||||
| Address2: | |||||||||
| City: | SANGER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936578754 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1105 E YALE AVE | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937046238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592521738 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2015 | ||||||||
| LastUpdateDate: | 06/28/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 106H00000X | 112165 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.