Provider Demographics
NPI:1730300070
Name:PASILLAS, JOE (MFTI)
Entity Type:Individual
Prefix:MR
First Name:JOE
Middle Name:
Last Name:PASILLAS
Suffix:
Gender:M
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4640 SPYRES WAY
Mailing Address - Street 2:BLDG B, STE 7
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-9800
Mailing Address - Country:US
Mailing Address - Phone:209-262-5226
Mailing Address - Fax:209-558-8031
Practice Address - Street 1:4640 SPYRES WAY
Practice Address - Street 2:BLDG B, STE 7
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-9800
Practice Address - Country:US
Practice Address - Phone:209-262-5226
Practice Address - Fax:209-558-8031
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46939106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist