Healthcare Provider Details

I. General information

NPI: 1437651684
Provider Name (Legal Business Name): SHAHNA DUERKSEN MA, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2018
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 BULLARD AVE STE 101
CLOVIS CA
93612-1057
US

IV. Provider business mailing address

400 BULLARD AVE STE 101
CLOVIS CA
93612-1057
US

V. Phone/Fax

Practice location:
  • Phone: 559-323-8484
  • Fax:
Mailing address:
  • Phone: 559-323-8484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number140986
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: