KIM STAFFORD FAHLEN LMFT
NPI 1720794712
Counselor - Mental Health in San Rafael, CA

NPI Status: Active since January 24, 2023

Contact Information

875 4TH ST STE 6
SAN RAFAEL, CA
ZIP 94901
Phone: (415) 578-2978

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  • Individual
  • Female
  • Counselor
  • Mental Health
  • Opted-Out Medicare

About KIM FAHLEN

This page provides the complete NPI Profile along with additional information for Kim Fahlen, a provider established in San Rafael, California with a medical specialization in Counselor, focusing in mental health . The healthcare provider is registered in the NPI registry with number 1720794712 assigned on January 2023. The practitioner's primary taxonomy code is 101YM0800X with license number 41746 (CA). The provider is registered as an individual and her NPI record was last updated 2 years ago.

NPI
1720794712
Provider Name
KIM STAFFORD FAHLEN LMFT
Gender
Female
Entity Type
Individual
Location Address
875 4TH ST STE 6 SAN RAFAEL, CA 94901
Location Phone
(415) 578-2978
Mailing Address
23 HACIENDA CT SAN RAFAEL, CA 94901
Mailing Phone
(415) 205-4034
Is Sole Proprietor?
Yes
Enumeration Date
01-24-2023
Last Update Date
01-24-2023
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A mental health counselor like Kim Fahlen provides treatment to individuals, families, couples, and groups for mental and emotional health issues and relationship problems. Mental health counselors treat clients with a variety of conditions, including anxiety, depression, grief, low self-esteem, stress, and suicidal impulses.

The provider doesn't accept Medicare and has signed an affidavit to be excluded from the Medicare program. If you are a Medicare beneficiary this means a provider can charge whatever they want for services rendered but must follow certain rules to do so. Kim Fahlen opted out of Medicare effective on 01-01-2024 until 01-01-2026. Opt out periods last for two years and cannot be terminated unless the provider is opting out for the very first time and the affidavit is terminated no later than 90 days after the opt out effective date. Opt-out affidavits might renew automatically renew every two years. The provider opted out of Medicare and cannot order and refer services to other healthcare providers.

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Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Counselor Mental Health

Taxonomy Code
101YM0800X
Type
Behavioral Health & Social Service Providers
License No.
41746
License State
CA

Medicare Participation & PECOS Enrollment Status

What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.

  • Opted-Out of Medicare? Yes

  • Opt-Out Effective Date: 01-01-2024

  • Opt-Out End Date: 01-01-2026

  • Eligible to Order and Refer? No

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NPI Validation Check Digit Calculation


The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1720794712
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2740149872
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 7 + 4 + 0 + 1 + 4 + 9 + 8 + 7 + 2 + 24 = 68
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
70 - 68 = 22

The NPI number 1720794712 is valid because the calculated check digit 2 using the Luhn validation algorithm matches the last digit of the original NPI number.

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1720794712, enumerated as an "individual" on January 24, 2023.

The provider is located at 875 4TH ST STE 6 SAN RAFAEL, CA 94901 and the phone number is (415) 578-2978.

Counselor with taxonomy code 101YM0800X and a focus in Mental Health.