=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699794701
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KRISTIN HIBBARD PHD A PROFESSIONAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7341 N 1ST ST STE 110
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93720-2948
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-292-6065
-----------------------------------------------------
Fax | 559-438-1051
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8839 N CEDAR AVE
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93720-1832
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-292-5606
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. KRISTIN HIBBARD
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 559-292-6065
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PSY19414
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------