Healthcare Provider Details

I. General information

NPI: 1730629379
Provider Name (Legal Business Name): KIMBERLYNN J SILVA LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLYNN SHAFFER LMFT 123292

II. Dates (important events)

Enumeration Date: 03/01/2017
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 POLLASKY AVE STE D
CLOVIS CA
93612-1159
US

IV. Provider business mailing address

106 POLLASKY AVE STE D
CLOVIS CA
93612-1159
US

V. Phone/Fax

Practice location:
  • Phone: 559-203-3775
  • Fax: 559-326-0607
Mailing address:
  • Phone: 559-203-3775
  • Fax: 559-326-0607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT107065
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT123292
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: