Healthcare Provider Details

I. General information

NPI: 1841686268
Provider Name (Legal Business Name): NICOLE KRAHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 02/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2934 N FRESNO ST
FRESNO CA
93703-1123
US

IV. Provider business mailing address

2658 E ALLUVIAL AVE APT 220
FRESNO CA
93720-9113
US

V. Phone/Fax

Practice location:
  • Phone: 559-549-6697
  • Fax:
Mailing address:
  • Phone: 559-824-1192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number130339
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: