Healthcare Provider Details

I. General information

NPI: 1699794701
Provider Name (Legal Business Name): KRISTIN HIBBARD PHD A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7341 N 1ST ST STE 110
FRESNO CA
93720-2948
US

IV. Provider business mailing address

8839 N CEDAR AVE
FRESNO CA
93720-1832
US

V. Phone/Fax

Practice location:
  • Phone: 559-292-6065
  • Fax: 559-438-1051
Mailing address:
  • Phone: 559-292-5606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY19414
License Number StateCA

VIII. Authorized Official

Name: DR. KRISTIN HIBBARD
Title or Position: OWNER
Credential: PHD
Phone: 559-292-6065