Provider Demographics
NPI:1841622388
Name:FLORES, NICHOLE ANDREA (PYSD)
Entity type:Individual
Prefix:DR
First Name:NICHOLE
Middle Name:ANDREA
Last Name:FLORES
Suffix:
Gender:F
Credentials:PYSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5530 W STUART AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-3166
Mailing Address - Country:US
Mailing Address - Phone:559-567-3911
Mailing Address - Fax:
Practice Address - Street 1:449 S MADERA AVE
Practice Address - Street 2:
Practice Address - City:KERMAN
Practice Address - State:CA
Practice Address - Zip Code:93630-1537
Practice Address - Country:US
Practice Address - Phone:559-364-2970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB37701101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health