Basic Information
Provider Information | |||||||||
NPI: | 1154755981 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | PARREIRA | ||||||||
FirstName: | KRYSTALINA | ||||||||
MiddleName: | BENTLEY | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MASTERS LMFT | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | BENTLEY | ||||||||
OtherFirstName: | KRYSTALINA | ||||||||
OtherMiddleName: | LOUISE | ||||||||
OtherNamePrefix: | MISS | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.S., IMF | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1830 S CENTRAL ST | ||||||||
Address2: |   | ||||||||
City: | VISALIA | ||||||||
State: | CA | ||||||||
PostalCode: | 932774418 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5597302969 | ||||||||
FaxNumber: | 5597302991 | ||||||||
Practice Location | |||||||||
Address1: | 1830 S CENTRAL ST | ||||||||
Address2: |   | ||||||||
City: | VISALIA | ||||||||
State: | CA | ||||||||
PostalCode: | 932774418 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5597302969 | ||||||||
FaxNumber: | 5597302991 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/28/2013 | ||||||||
LastUpdateDate: | 10/11/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 10/11/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X |   | CA | N |   | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | IMF 74979 | CA | N |   | Behavioral Health & Social Service Providers | Marriage & Family Therapist |   | 106H00000X | LMFT97022 | CA | Y |   | Behavioral Health & Social Service Providers | Marriage & Family Therapist |   |
No ID Information.