Provider Demographics
NPI:1427659762
Name:BROOKSHIRE-CLUTTER, TINA PATRICIA (AMFT)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:PATRICIA
Last Name:BROOKSHIRE-CLUTTER
Suffix:
Gender:
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2747 N REDDA RD
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93737-9619
Mailing Address - Country:US
Mailing Address - Phone:559-375-1413
Mailing Address - Fax:
Practice Address - Street 1:2747 N REDDA RD
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93737-9619
Practice Address - Country:US
Practice Address - Phone:559-375-1413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT148887106H00000X
CA148887106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist