Provider Demographics
NPI:1093069098
Name:BECKER, KIMBERLY ROBIN (IMF)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ROBIN
Last Name:BECKER
Suffix:
Gender:F
Credentials:IMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 W SAMPLE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-1537
Mailing Address - Country:US
Mailing Address - Phone:559-301-3710
Mailing Address - Fax:
Practice Address - Street 1:2610 W SHAW LN
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-2775
Practice Address - Country:US
Practice Address - Phone:559-709-6904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-30
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 70930101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health