Provider Demographics
NPI:1518128693
Name:CANOSA, PABLO JOSE (LMFT)
Entity Type:Individual
Prefix:
First Name:PABLO
Middle Name:JOSE
Last Name:CANOSA
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:PABLO
Other - Middle Name:JOSE
Other - Last Name:CANOSA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:2934 N FRESNO ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-1123
Mailing Address - Country:US
Mailing Address - Phone:559-549-6697
Mailing Address - Fax:
Practice Address - Street 1:2934 N FRESNO ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703-1123
Practice Address - Country:US
Practice Address - Phone:559-549-6697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-20
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CA53695106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist