Provider Demographics
NPI:1437223534
Name:COSTELLO, FRAN ANN (MFT)
Entity Type:Individual
Prefix:MRS
First Name:FRAN
Middle Name:ANN
Last Name:COSTELLO
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2388 GOLDEN BEAR CIR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-1765
Mailing Address - Country:US
Mailing Address - Phone:209-598-0809
Mailing Address - Fax:
Practice Address - Street 1:8900 THORNTON RD
Practice Address - Street 2:SUITE 6
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-1820
Practice Address - Country:US
Practice Address - Phone:209-474-3445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC43939103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst