Provider Demographics
NPI:1780041335
Name:BADAL, ASHOUR
Entity Type:Individual
Prefix:DR
First Name:ASHOUR
Middle Name:
Last Name:BADAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2665 CARMICHAEL WAY
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-9138
Mailing Address - Country:US
Mailing Address - Phone:209-529-7807
Mailing Address - Fax:209-529-7919
Practice Address - Street 1:909 15TH ST STE 8
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-1130
Practice Address - Country:US
Practice Address - Phone:209-529-7807
Practice Address - Fax:209-529-7919
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-26
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA132974106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist