NPIMap

Organization Active NPI

Fresno Family Therapy

  • Marriage & Family Therapist
  • Fresno, CA
National Provider Identifier
1174016240
Registry record updated Apr 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
104484 Issued in CA
Legal business name
FRESNO FAMILY THERAPY
Practice address
745 E Locust Ave Ste 106
Fresno, CA 93720-3000
Phone
(559) 795-5990
NPI assigned
Jun 12, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Daniel Moultrie, LMFTNPI 1043623994
Title
LMFT
Phone
(559) 285-6364

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X 104484 CA Primary
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X 105969 CA

Addresses

Primary practice location

745 E Locust Ave Ste 106
Fresno, CA 93720-3000

Mailing address

550 W Alluvial Ave Ste 108
Fresno, CA 93711-5857
Phone (559) 285-6364

Other identifiers 1

IdentifierTypeStateIssuer
UNKNOWNOtherUNKNOWN

Other names 1

  • Fresno Family Therapy Doing business as

National Provider Directory

National Provider Directory

Locations

1598 Shaw Ave
Clovis, CA 93611
Phone (209) 564-0255

550 W Alluvial Ave
Fresno, CA 93711

745 E Locust Ave
Ste 106
Fresno, CA 93720
Phone (559) 479-9224

377 W Fallbrook Ave
Ste 105
Fresno, CA 93711
Phone (559) 795-5990

377 W Fallbrook Ave
Ste 106
Fresno, CA 93711
Phone (559) 474-0424

Practitioners & affiliated clinicians

Practitioners 34

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 34

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1528761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618358400000",
    "number": "1174016240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 W ALLUVIAL AVE STE 108",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937115857",
            "telephone_number": "559-285-6364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "745 E LOCUST AVE STE 106",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937203000",
            "telephone_number": "559-795-5990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRESNO FAMILY THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-12",
        "last_updated": "2021-04-14",
        "certification_date": "2021-04-14",
        "status": "A",
        "authorized_official_last_name": "MOULTRIE",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "LMFT",
        "authorized_official_telephone_number": "559-285-6364",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "104484",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "105969",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNKNOWN",
            "identifier": "UNKNOWN",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fresno Family Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fresno, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.