Healthcare Provider Details

I. General information

NPI: 1437326121
Provider Name (Legal Business Name): MISS MABEL MUNOZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

KERN BEHAVIORAL HEALTH AND RECOVERY SERVICES 2525 NORTH CHESTER AVE
BAKERSFIELD CA
93308
US

IV. Provider business mailing address

KERN BEHAVIORAL HEALTH AND RECOVERY SERVICES 2525 NORTH CHESTER AVE.
BAKERSFIELD CA
93308-1770
US

V. Phone/Fax

Practice location:
  • Phone: 661-868-1888
  • Fax:
Mailing address:
  • Phone: 661-868-1834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number94028392
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: