=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346639499
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DIANNE A. BURKES-BELL L.M.F.T
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2015
-----------------------------------------------------
Last Update Date | 01/13/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5070 N. 6TH ST. SUITE 109
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93710
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-250-9677
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2652 E. FALLBROOK AVE.
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-250-9677
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | LMFT43682
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------