Individual provider Active NPI

Elizabeth Choua Mouavangsou, LMFT

  • Marriage & Family Therapist
  • Fresno, CA
National Provider Identifier
1275878530
Registry record updated Jun 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
LMFT111460 Issued in CA
Practice address
1300 W Shaw Ave Ste 3a
Fresno, CA 93711-3712
Phone
(559) 840-8800
Fax
(559) 840-8889
NPI assigned
Nov 27, 2012
Last updated
Jun 20, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 20, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X LMFT111460 CA Primary

Addresses

Primary practice location

1300 W Shaw Ave Ste 3a
Fresno, CA 93711-3712

Mailing address

2087 W Shaw Ave # 257
Fresno, CA 93711-3404
Phone (559) 840-8800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
LMFT111460CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Blossom Growth Family Therapy, Inc Marriage & Family Therapist CurrentSince Feb 9, 2025 Accepting new patients

Locations

1300 W Shaw Ave
Ste 3A
Fresno, CA 93711
Phone (559) 202-3390

2087 W Shaw Ave
Fresno, CA 93711

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1353974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750377600000",
    "number": "1275878530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2087 W SHAW AVE # 257",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937113404",
            "telephone_number": "559-840-8800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 W SHAW AVE STE 3A",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937113712",
            "telephone_number": "559-840-8800",
            "fax_number": "559-840-8889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOUAVANGSOU",
        "first_name": "ELIZABETH",
        "middle_name": "CHOUA",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-11-27",
        "last_updated": "2025-06-20",
        "certification_date": "2025-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "LMFT111460",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Jun 20, 2025; 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.