Healthcare Provider Details

I. General information

NPI: 1932531233
Provider Name (Legal Business Name): AMY ROCHELLE DURST LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMY ROCHELLE BORGES LMFT 102883

II. Dates (important events)

Enumeration Date: 08/08/2013
Last Update Date: 04/25/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5215 W NOBLE AVE STE 102
VISALIA CA
93277-8355
US

IV. Provider business mailing address

PO BOX 7957
VISALIA CA
93290-7957
US

V. Phone/Fax

Practice location:
  • Phone: 559-707-7717
  • Fax: 559-608-5707
Mailing address:
  • Phone: 559-707-7717
  • Fax: 559-608-5707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number102883
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: