Provider Demographics
NPI:1295850113
Name:STRATFORD, KENT LEE (MASTER OF SCIENCE)
Entity Type:Individual
Prefix:MR
First Name:KENT
Middle Name:LEE
Last Name:STRATFORD
Suffix:
Gender:M
Credentials:MASTER OF SCIENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 N 6TH ST
Mailing Address - Street 2:SUITE 135
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-7514
Mailing Address - Country:US
Mailing Address - Phone:559-221-5136
Mailing Address - Fax:559-221-8307
Practice Address - Street 1:5100 N 6TH ST
Practice Address - Street 2:SUITE 135
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-7514
Practice Address - Country:US
Practice Address - Phone:559-221-5136
Practice Address - Fax:559-221-8307
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC31468101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health