Provider Demographics
NPI:1679755201
Name:KAMBOURIAN, DEBRA LYNN (LMFT)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:LYNN
Last Name:KAMBOURIAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:LYNN
Other - Last Name:WATTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:PO BOX 1056
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93279-1056
Mailing Address - Country:US
Mailing Address - Phone:559-737-1075
Mailing Address - Fax:559-802-3679
Practice Address - Street 1:4126 S DEMAREE ST STE A
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-9514
Practice Address - Country:US
Practice Address - Phone:559-737-1075
Practice Address - Fax:559-802-3679
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health