Healthcare Provider Details

I. General information

NPI: 1891866992
Provider Name (Legal Business Name): ERIC KUNKEL PSY.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 S CEDAR AVE
FRESNO CA
93702-2907
US

IV. Provider business mailing address

4910 E CLINTON WAY SUITE 101
FRESNO CA
93727-1560
US

V. Phone/Fax

Practice location:
  • Phone: 559-499-6464
  • Fax: 559-499-6463
Mailing address:
  • Phone: 559-453-5203
  • Fax: 559-453-3321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY 14931
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: