Provider Demographics
NPI:1639512049
Name:NALL, SUNSHINE S (MS LMFT)
Entity Type:Individual
Prefix:MRS
First Name:SUNSHINE
Middle Name:S
Last Name:NALL
Suffix:
Gender:F
Credentials:MS LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 TULARE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-2281
Mailing Address - Country:US
Mailing Address - Phone:559-265-3081
Mailing Address - Fax:
Practice Address - Street 1:2440 TULARE ST STE 200
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-2281
Practice Address - Country:US
Practice Address - Phone:559-265-3081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-16
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70714106H00000X
CA92767106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA946000512Medicaid