Healthcare Provider Details

I. General information

NPI: 1689579807
Provider Name (Legal Business Name): KENDRA MIRANDA AMFT, APCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KENDRA MIRANDA GREER APCC, AMFT

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6839 CODY ST
BONNERS FERRY ID
83805-8613
US

IV. Provider business mailing address

1420 SHAW AVE STE 102301
CLOVIS CA
93611-4072
US

V. Phone/Fax

Practice location:
  • Phone: 559-712-4660
  • Fax:
Mailing address:
  • Phone: 559-712-4660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number160740
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: