Healthcare Provider Details

I. General information

NPI: 1609337377
Provider Name (Legal Business Name): KINNE MARRIAGE AND FAMILY THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 12/30/2019
Certification Date: 12/30/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 MAIN ST
QUINCY CA
95971-9494
US

IV. Provider business mailing address

PO BOX 321
QUINCY CA
95971-0321
US

V. Phone/Fax

Practice location:
  • Phone: 530-283-2465
  • Fax: 530-410-0010
Mailing address:
  • Phone: 530-283-2465
  • Fax: 530-410-0010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ALLISON MAKENA KINNE
Title or Position: DIRECTOR
Credential: LMFT
Phone: 916-547-9961