Provider Demographics
NPI:1245943794
Name:MARC ANTONIO LMFT
Entity type:Organization
Organization Name:MARC ANTONIO LMFT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTONIO
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:559-245-2468
Mailing Address - Street 1:373 E SHAW AVE # 135
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-7609
Mailing Address - Country:US
Mailing Address - Phone:559-245-2468
Mailing Address - Fax:559-702-6107
Practice Address - Street 1:1300 W SHAW AVE STE 3A
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3712
Practice Address - Country:US
Practice Address - Phone:559-245-2468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-29
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty