Provider Demographics
NPI:1205370400
Name:ORNELAS, MIGUEL (LCSW)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:
Last Name:ORNELAS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 N FINE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-1528
Mailing Address - Country:US
Mailing Address - Phone:559-457-5650
Mailing Address - Fax:559-457-5695
Practice Address - Street 1:PSYCHIATRIC HEALTH FACILITY
Practice Address - Street 2:4411 E. KINGS CANYON RD #319
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93702-9370
Practice Address - Country:US
Practice Address - Phone:559-600-2382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-07
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW924051041C0700X
CA69182104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical