Provider Demographics
NPI:1982890109
Name:OVALLE, RICHARD XAVIER JR
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:XAVIER
Last Name:OVALLE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7080 N MARKS AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-0288
Mailing Address - Country:US
Mailing Address - Phone:559-248-8550
Mailing Address - Fax:559-248-8555
Practice Address - Street 1:7080 N MARKS AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-0288
Practice Address - Country:US
Practice Address - Phone:559-248-8550
Practice Address - Fax:559-248-8555
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)