Provider Demographics
NPI:1649301235
Name:KIBEL, SHARLA RUTH (MS, LMFT)
Entity type:Individual
Prefix:MS
First Name:SHARLA
Middle Name:RUTH
Last Name:KIBEL
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:SHARLA
Other - Middle Name:
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4525 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-3530
Mailing Address - Country:US
Mailing Address - Phone:408-558-5460
Mailing Address - Fax:408-558-5571
Practice Address - Street 1:4525 UNION AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-3530
Practice Address - Country:US
Practice Address - Phone:408-558-5460
Practice Address - Fax:408-558-5571
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMCC 27284106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist