Provider Demographics
NPI:1427488485
Name:PATEL, TEJAL J (MFT)
Entity type:Individual
Prefix:
First Name:TEJAL
Middle Name:J
Last Name:PATEL
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:TEJAL
Other - Middle Name:
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:133 DENALI
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-7632
Mailing Address - Country:US
Mailing Address - Phone:559-493-8200
Mailing Address - Fax:
Practice Address - Street 1:978 W ALLUVIAL AVE STE 107
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-5502
Practice Address - Country:US
Practice Address - Phone:559-478-9153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-12
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100043AN101YA0400X
CA77631106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101044Medicaid