KIM STAFFORD FAHLEN LMFT
NPI 1720794712
Counselor - Mental Health in San Rafael, CA
About Kim Stafford Fahlen Lmft NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
KIM STAFFORD FAHLEN LMFT (NPI 1720794712) is an individual mental health provider in San Rafael, California, licensed in California (41746) and active in the NPI registry since January 2023. She has opted out of Medicare through January 1, 2028.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
Opted out of Medicare
Kim Stafford Fahlen Lmft has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from January 1, 2024 through January 1, 2028.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Kim Fahlen's NPI number?
The NPI number for Kim Fahlen is 1720794712. It was assigned to this individual provider in the NPPES registry on January 24, 2023.
Where is Kim Fahlen located?
Kim Fahlen practices at 875 4th St Ste 6, San Rafael, CA 94901. The listed phone number is (415) 578-2978.
What is Kim Fahlen's specialty?
The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.
Is Kim Fahlen enrolled in Medicare?
No. Kim Fahlen has opted out of Medicare through January 1, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.
When was this NPI record last updated?
The NPPES record for Kim Fahlen was last updated on January 24, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Kim Stafford Fahlen, LMFT · NPI 1720794712
Mental Health provider in San Rafael, California. Individual provider, active in the CMS NPPES registry since January 24, 2023.
## Identity
- **NPI:** 1720794712 (Entity type: Individual)
- **Enumerated:** January 24, 2023
- **Primary specialty:** Counselor - Mental Health · taxonomy 101YM0800X
- **State license:** 41746 (California)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 875 4TH ST STE 6, San Rafael, CA 94901-3242
- **Phone:** (415) 578-2978
## Medicare
- **Medicare:** Opted out of Medicare (opt-out affidavit on file, in effect through January 1, 2028); services are provided under private contract
## Record status
- **NPPES last updated:** January 24, 2023
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Source: [NPI Profile](https://npiprofile.com/npi/1720794712) · Data from the CMS NPPES public registry.