Healthcare Provider Details

I. General information

NPI: 1114498441
Provider Name (Legal Business Name): KITTY KELSEY AHRENS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4604A ROOSEVELT AVE
SACRAMENTO CA
95820-4520
US

IV. Provider business mailing address

18225 HALE AVE
MORGAN HILL CA
95037-3547
US

V. Phone/Fax

Practice location:
  • Phone: 916-457-3129
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number86266
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: