Provider Demographics
NPI:1932477742
Name:BACON, HIROMI KURIHARA
Entity Type:Individual
Prefix:
First Name:HIROMI
Middle Name:KURIHARA
Last Name:BACON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HIROMI
Other - Middle Name:
Other - Last Name:KURIHARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
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:559-600-9171
Mailing Address - Fax:559-600-7615
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:559-600-9171
Practice Address - Fax:559-600-7615
Is Sole Proprietor?:No
Enumeration Date:2011-12-07
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CALCSW721441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health