Provider Demographics
NPI:1447376405
Name:PACHECO, MYRNA (MS)
Entity type:Individual
Prefix:MRS
First Name:MYRNA
Middle Name:
Last Name:PACHECO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1787 N KAREN AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-0438
Mailing Address - Country:US
Mailing Address - Phone:559-892-9284
Mailing Address - Fax:559-322-6393
Practice Address - Street 1:1787 N KAREN AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93619-0438
Practice Address - Country:US
Practice Address - Phone:559-892-9284
Practice Address - Fax:559-322-6393
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51131106H00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101YM0800XMedicare ID - Type UnspecifiedMFTI