Provider Demographics
NPI:1578619581
Name:MIAN, IJAZ-UL-HAQ (LCSW)
Entity Type:Individual
Prefix:MR
First Name:IJAZ-UL-HAQ
Middle Name:
Last Name:MIAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:IJAZ
Other - Middle Name:
Other - Last Name:MIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSC, MSW, LCSW
Mailing Address - Street 1:4441 E KINGS CANYON RD
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93702-3604
Mailing Address - Country:US
Mailing Address - Phone:559-453-4099
Mailing Address - Fax:559-453-8659
Practice Address - Street 1:4441 E KINGS CANYON RD
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93702-3604
Practice Address - Country:US
Practice Address - Phone:559-453-4099
Practice Address - Fax:559-453-8659
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS170651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ02210Medicare PIN
CAR38241Medicare UPIN