Healthcare Provider Details

I. General information

NPI: 1629483540
Provider Name (Legal Business Name): KRYSTA PILAR MEANY PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2014
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 N KAREN AVE
CLOVIS CA
93611-7171
US

IV. Provider business mailing address

1033 N KAREN AVE
CLOVIS CA
93611-7171
US

V. Phone/Fax

Practice location:
  • Phone: 858-357-6340
  • Fax: 559-387-5279
Mailing address:
  • Phone: 858-357-6340
  • Fax: 559-387-5279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number27556
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: