Individual
MYTZY ISIDORO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2416 W SHAW AVE STE 107, FRESNO, CA 93711-3303
(559) 558-4051
Mailing address
3433 W SHAW AVE STE 102, FRESNO, CA 93711-3229
(559) 558-4051
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YP2500X
Professional Counselor
Primary
12862
CA
106S00000X
Behavior Technician
—
—
Other
Enumeration date
03/16/2019
Last updated
05/13/2026
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