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General NPI Number Information
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NPI Number | 1750656096
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Entity Type | Individual
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Provider Name | KELLINE LYNN HIDAY PSY.D., LPC, RPT
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Gender | Female
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Dates
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Enumeration Date | 03/20/2012
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Last Update Date | 08/06/2020
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Provider Practice Location Address
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Address Line | 3447 W SHAW AVE STE 102
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City | FRESNO
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State | CA
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Zip | 93711-3251
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Country | US
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Telephone | 949-461-1945
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Fax |
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Provider Business Mailing Address
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Address Line | 3447 W SHAW AVE STE 102
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City | FRESNO
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State | CA
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Zip | 93711-3251
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Country | US
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Telephone | 949-461-1945
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSB94025077
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License Number State | CA
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