Kassandra Ariana Banuelos
Individual provider Active NPI Marriage & Family Therapist · Clovis, CA
NPI 1154832780 · NPPES record last updated Jan 6, 2025
Key facts
- NPI
- 1154832780
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Marriage & Family Therapist 106H00000X
- License
- 150145 (CA)
- Practice address
- 255 W Bullard Ave Ste 101
Clovis, CA 93612-0861 - Phone
- (559) 248-8550
- NPI assigned
- Oct 23, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Marriage and Family Therapist
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Central Valley Indian Health Inc
Practice addresses (Care Compare)
255 W Bullard Ave
Suite 109
Clovis, CA 93612-0861
Phone (559) 325-5715
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250120000807 | CA | Practitioner - Marriage and Family Therapist | 9234668310 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 141597 | CA | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Central Valley Indian Health, Inc | Current |
Accepting new patients | |
| Central Valley Indian Health, Inc. | Current |
Accepting new patients | |
| Central Valley Indian Health Inc | Current | Accepting new patients |
Locations
255 W Bullard Ave
Ste 109
Clovis, CA 93612
Phone (559) 297-7563
2740 Herndon Ave
Clovis, CA 93611
Phone (559) 299-2608
29369 Auberry Rd
Ste 102
Prather, CA 93651
Phone (559) 855-5390
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | |||
| Marriage & Family Therapist | 106H00000X | 141597 | CA | |
| Marriage & Family Therapist | 106H00000X | 150145 | CA | Yes |
Addresses
Primary practice location
255 W Bullard Ave Ste 101
Clovis, CA 93612-0861
Mailing address
2740 Herndon Ave
Clovis, CA 93611-6813
Other providers in Clovis, CA
- Rebekah Rose Baltis
- Archana Bangalore
- Parmala Kumari Bangar
- Christian Banks
- Jordan Banuelos
- Maria Barajas-McGahan
- Renato Barga
- Brooklynn Nicole Barksdale I
- Jordan Barnett
- Kathleen Baron
All providers in Clovis, CA · Marriage & Family Therapist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 6, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.