1245809052 NPI number — MRS. HALEY INGRID FUENTES LMFT

Table of content: MRS. HALEY INGRID FUENTES LMFT (NPI 1245809052)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245809052 NPI number — MRS. HALEY INGRID FUENTES LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FUENTES
Provider First Name:
HALEY
Provider Middle Name:
INGRID
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FUENTES
Provider Other First Name:
HALEY
Provider Other Middle Name:
INGRID
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMFT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1245809052
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/24/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
698 N CLAREMONT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLOVIS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93611-7304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-681-8311
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
550 W ALLUVIAL AVE STE 108
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93711-5857
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-795-5990
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/24/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  124427 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)