Healthcare Provider Details

I. General information

NPI: 1083853626
Provider Name (Legal Business Name): KATY LUALLEN MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2009
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 WALL ST STE 1
CHICO CA
95928-7800
US

IV. Provider business mailing address

315 WALL ST STE 1
CHICO CA
95928-7800
US

V. Phone/Fax

Practice location:
  • Phone: 530-828-1876
  • Fax:
Mailing address:
  • Phone: 530-828-1876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number43453
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: