Basic Information
| Provider Information | |||||||||
| NPI: | 1760861702 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HO | ||||||||
| FirstName: | JOSEPHINE | ||||||||
| MiddleName: | PENALBA-OLDAN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LMFT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | OLDAN | ||||||||
| OtherFirstName: | JOSEPHINE | ||||||||
| OtherMiddleName: | PENALBA | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4785 N 1ST ST | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937260500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594484708 | ||||||||
| FaxNumber: | 5594484950 | ||||||||
| Practice Location | |||||||||
| Address1: | 1830 S CENTRAL ST | ||||||||
| Address2: | |||||||||
| City: | VISALIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932774418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5597302969 | ||||||||
| FaxNumber: | 5597302991 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2015 | ||||||||
| LastUpdateDate: | 04/24/2020 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 04/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | IMF 85095 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | 101192 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.