Healthcare Provider Details

I. General information

NPI: 1346547866
Provider Name (Legal Business Name): VICTORIA KUBAL LMFT, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2011
Last Update Date: 01/18/2021
Certification Date: 01/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49774 ROAD 426 STE D
OAKHURST CA
93644-8691
US

IV. Provider business mailing address

PO BOX 4043
CLOVIS CA
93613-4043
US

V. Phone/Fax

Practice location:
  • Phone: 559-683-4809
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-04-1645
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMFT97693
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: