Provider Demographics
NPI:1295900272
Name:CASILLAS, JENNELL ANDREA (MA LMFT)
Entity type:Individual
Prefix:MISS
First Name:JENNELL
Middle Name:ANDREA
Last Name:CASILLAS
Suffix:
Gender:F
Credentials:MA LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 E SHAW AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-7708
Mailing Address - Country:US
Mailing Address - Phone:559-513-5889
Mailing Address - Fax:559-468-6141
Practice Address - Street 1:770 E SHAW AVE STE 103
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-7708
Practice Address - Country:US
Practice Address - Phone:559-513-5889
Practice Address - Fax:559-468-6141
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81828106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist