Provider Demographics
NPI:1952919979
Name:AMEZCUA, KATRINA MICHELLE (APCC)
Entity Type:Individual
Prefix:MISS
First Name:KATRINA
Middle Name:MICHELLE
Last Name:AMEZCUA
Suffix:
Gender:F
Credentials:APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2037 W BULLARD AVE # 245
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-1200
Mailing Address - Country:US
Mailing Address - Phone:559-825-1205
Mailing Address - Fax:
Practice Address - Street 1:1357 W SHAW AVE STE 100
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3619
Practice Address - Country:US
Practice Address - Phone:559-825-1205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7907101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health