1568750131 NPI number — MS. JO ELLEN S. FLETCHER LMFT

Table of content: MS. JO ELLEN S. FLETCHER LMFT (NPI 1568750131)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568750131 NPI number — MS. JO ELLEN S. FLETCHER LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLETCHER
Provider First Name:
JO ELLEN
Provider Middle Name:
S.
Provider Name Prefix Text:
MS.
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568750131
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5014 CHESEBRO RD.
Provider Second Line Business Mailing Address:
FIRST FLOOR
Provider Business Mailing Address City Name:
AGOURA HILL
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-367-6080
Provider Business Mailing Address Fax Number:
818-896-5069

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5014 CHESEBRO RD.
Provider Second Line Business Practice Location Address:
FIRST FLOOR
Provider Business Practice Location Address City Name:
AGOURA HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-367-6080
Provider Business Practice Location Address Fax Number:
818-896-5069
Provider Enumeration Date:
07/18/2011

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: LMFT85238 , 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)

  • Identifier: 7068 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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