Provider Demographics
NPI:1629483540
Name:MEANY, KRYSTA PILAR (PSYD)
Entity Type:Individual
Prefix:
First Name:KRYSTA
Middle Name:PILAR
Last Name:MEANY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 N KAREN AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-7171
Mailing Address - Country:US
Mailing Address - Phone:858-357-6340
Mailing Address - Fax:559-387-5279
Practice Address - Street 1:1033 N KAREN AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-7171
Practice Address - Country:US
Practice Address - Phone:858-357-6340
Practice Address - Fax:559-387-5279
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27556103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical