Healthcare Provider Details

I. General information

NPI: 1316953003
Provider Name (Legal Business Name): KIMBERLY KAY EHRLICH L.M.F.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2819 CROW CANYON RD SUITE 219E
SAN RAMON CA
94583-1655
US

IV. Provider business mailing address

2819 CROW CANYON RD SUITE 219E
SAN RAMON CA
94583-1655
US

V. Phone/Fax

Practice location:
  • Phone: 925-301-6523
  • Fax:
Mailing address:
  • Phone: 925-301-6523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC40502
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: