1851756092 NPI number — MRM FAMILY COUNSELING SERVICES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851756092 NPI number — MRM FAMILY COUNSELING SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MRM FAMILY COUNSELING SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1851756092
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1300 E SHAW AVE STE 149
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93710-7903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-473-3632
Provider Business Mailing Address Fax Number:
559-554-9711

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1300 E SHAW AVE
Provider Second Line Business Practice Location Address:
SUITE 172
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93710-7917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-472-3587
Provider Business Practice Location Address Fax Number:
559-472-3587
Provider Enumeration Date:
12/15/2015

Additional Information

Authorized Official

Authorized Official Last Name:
MCCOY
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
RENEE
Authorized Official Title or Position:
CLINICAL DIRECTOR
Authorized Official Telephone Number:
559-554-9710

Provider Taxonomy Codes

  • Taxonomy code: 103TC1900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: 80212 , 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: 1649395419 . This is a "INDIVIDUAL NPI NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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