=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932531233
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMY ROCHELLE DURST LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2013
-----------------------------------------------------
Last Update Date | 04/25/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5215 W NOBLE AVE STE 102
-----------------------------------------------------
City | VISALIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93277-8355
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-707-7717
-----------------------------------------------------
Fax | 559-608-5707
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 7957
-----------------------------------------------------
City | VISALIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93290-7957
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-707-7717
-----------------------------------------------------
Fax | 559-608-5707
-----------------------------------------------------
=====================================================
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 | 102883
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------