Provider Demographics
NPI:1477836476
Name:SPEAKES, ELEANOR OCTAVIA (LCSW, PPSC)
Entity Type:Individual
Prefix:MRS
First Name:ELEANOR
Middle Name:OCTAVIA
Last Name:SPEAKES
Suffix:
Gender:F
Credentials:LCSW, PPSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 N VAN NESS BLVD
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-6013
Mailing Address - Country:US
Mailing Address - Phone:559-313-1837
Mailing Address - Fax:559-226-9560
Practice Address - Street 1:2004 N VAN NESS BLVD
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-6013
Practice Address - Country:US
Practice Address - Phone:559-313-1837
Practice Address - Fax:559-226-9560
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS25592101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health