JEREMIAH SERON ELLARD (NPI# 1346425204) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1346425204 |
| Entity Type | Individual |
| Full Name | JEREMIAH SERON ELLARD |
| Practice Address |
114 E Shaw Ave Ste 210 Fresno CA 93710-7621 |
| Mailing Address |
4325 N Chestnut Ave Apt 108 Fresno CA 93726-2952 |
| Practice Telephone | 5592218100 |
| Practice Fax Number | 5592218101 |
| Mailing Telephone | 5593752696 |
| Enumeration Date | 2008-01-09 |
| Last Update Date | 2008-01-09 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | MEDI-CAL | 101076 | 01 |
| Street Address |
114 E SHAW AVE STE 210 |
| City | FRESNO |
| State | CA |
| Zip Code | 93710-7621 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194851410 | Joey Jesse Reynoso | Counselor | 114 E Shaw Ave Ste 210, Fresno, CA 93710-7621 | 2007-02-23 |
| 1144820929 | Brittany N Collins | Counselor | 114 E Shaw Ave Ste 210, Fresno, CA 93710-7621 | 2020-10-29 |
| 1255931796 | Katie A Counts | Community/Behavioral Health | 114 E Shaw Ave Ste 210, Fresno, CA 93710-7621 | 2020-10-26 |
| 1760939847 | Kyjo Enterprises, Inc. | Community/Behavioral Health | 114 E Shaw Ave Ste 210, Fresno, CA 93710-7621 | 2016-09-06 |
| 1225344732 | Dawn Louise Frenette | Counselor | 114 E Shaw Ave Ste 210, Fresno, CA 93710-7621 | 2010-08-20 |
| 1700191905 | Forest Albion Ray | Counselor | 114 E Shaw Ave Ste 210, Fresno, CA 93710-7621 | 2010-08-11 |
| 1972818177 | Jocelyn M Turner | Counselor | 114 E Shaw Ave Ste 210, Fresno, CA 93710-7621 | 2010-08-11 |
| 1992010458 | Juan Luis Tienda | Counselor | 114 E Shaw Ave Ste 210, Fresno, CA 93710-7621 | 2010-08-09 |
| 1811202377 | Joshua Ryan Lozano | Counselor | 114 E Shaw Ave Ste 210, Fresno, CA 93710-7621 | 2010-08-09 |
| 1336475797 | Dena Leann Balderama | Counselor | 114 E Shaw Ave Ste 210, Fresno, CA 93710-7621 | 2009-10-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184240384 | Patsy Joan Perry | Counselor | Quality Family Services - Sample House, 643 E. Sample Avenue, Fresno, CA 93710 | 2020-06-23 |
| 1831739853 | Blanca Stephanie Millan | Counselor | 1300 E Shaw Ave Suite 172, Fresno, CA 93710 | 2020-01-07 |
| 1679115737 | Abel Luis Flores | Physical Therapy Assistant | 5556 N Fresno St, 5555 N Fresno St, Fresno, CA 93710 | 2019-10-10 |
| 1316408933 | Simranjit Kaur Mann | Behavioral Analyst | 5180 North Primitivo Way Appt #363, Fresno, CA 93710 | 2019-03-27 |
| 1093274169 | Aleajndra Bedolla Alcantar | Behavior Technician | 1320 East Shaw Ave, #110, Fresno, CA 93710 | 2019-03-18 |
| 1790244960 | Alondra Martinez | Behavior Technician | 1320 East Shaw Ave #110, Fresno, CA 93710 | 2019-03-18 |
| 1235698622 | Irma Joselyn Castro | Behavior Technician | 1320 East Shaw Ave # 110, Fresno, CA 93710 | 2019-03-15 |
| 1619433711 | Beacon Dental Group | Dentist | 6099 N. First Ste Ste 102, Fresno, CA 93710 | 2019-02-13 |
| 1265909394 | Pathana Phonesy | Behavior Technician | 5363 N. Fresno St., Suite 105, Fresno, CA 93710 | 2018-10-26 |
| 1376030080 | Jane F Kardashian Md Inc | Non-Pharmacy Dispensing Site | 6769 N Fresno, Fresno, CA 93710 | 2018-04-18 |
| Find all providers in zip 93710 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164022976 | Denise Renee Hands | Counselor | 4604 E Terrace Ave, Fresno, CA 93703-2079 | 2020-10-30 |
| 1649807694 | Debbie Jeneen Darden | Counselor | 891 W Kearney Blvd, Fresno, CA 93706-2514 | 2020-03-26 |
| 1205466802 | Elizabeth C Esqueda | Counselor | 804 S Parallel Ave, Fresno, CA 93721-2404 | 2020-01-22 |
| 1295378446 | Caussaundra Maria Dominguez | Counselor | 2772 S Martin Luther King, Fresno, CA 93706 | 2019-10-21 |
| 1881244945 | Aurelio Mendoza | Counselor | 1414 W. Kearney Blvd, Fresno, CA 93706 | 2019-09-19 |
| 1356994909 | Joaquin Sanchez | Counselor | Quest House 2731 W Olive Ave, Fresno, CA 93728 | 2019-07-23 |
| 1003374539 | Jasmine Elizabeth Flores | Counselor | 2772 S Martin Luther King Junior Blvd, Fresno, CA 93706 | 2019-03-04 |
| 1104397348 | Brian K Bradley | Counselor | 2212 N Winery Ave, Fresno, CA 93703-2896 | 2018-12-16 |
| 1063982049 | Bruno Sivongxay | Counselor | 2772 South Martin L King Jr Blvd, Fresno, CA 93706 | 2018-12-03 |
| 1831669951 | Ashlee Faith Vasquez | Counselor | 1900 N Gateway Blvd Ste 100, Fresno, CA 93727-1622 | 2018-12-01 |
| Find all providers in FRESNO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.