Provider Demographics
NPI:1417173873
Name:GIRARDEAU, AEL LEN (RAS)
Entity Type:Individual
Prefix:
First Name:AEL
Middle Name:LEN
Last Name:GIRARDEAU
Suffix:
Gender:M
Credentials:RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:542 E CORNELL AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-5417
Mailing Address - Country:US
Mailing Address - Phone:559-225-6824
Mailing Address - Fax:
Practice Address - Street 1:424 N GATEWAY DR
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-3142
Practice Address - Country:US
Practice Address - Phone:559-675-7762
Practice Address - Fax:559-673-6991
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)