1972855146 NPI number — FAMILY FOUNDATIONS COUNSELING SERVICES

Table of content: ANNA KLINE MA, LPCC (NPI 1962727602)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972855146 NPI number — FAMILY FOUNDATIONS COUNSELING SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY FOUNDATIONS COUNSELING SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972855146
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4304
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93744-4304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-709-6904
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2610 W SHAW LN
Provider Second Line Business Practice Location Address:
#104
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93711-2775
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-709-6904
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/11/2012

Additional Information

Authorized Official

Authorized Official Last Name:
HEPPNER
Authorized Official First Name:
PEARL
Authorized Official Middle Name:
DELIGHT
Authorized Official Title or Position:
CLINICAL DIRECTOR
Authorized Official Telephone Number:
559-709-6904

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFC40217 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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