Healthcare Provider Details

I. General information

NPI: 1912483983
Provider Name (Legal Business Name): KATRINA MARY BOBO IMFT 97106, PCCI 354
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATRINA MARY SPRAGGINS

II. Dates (important events)

Enumeration Date: 07/12/2018
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 GREAT AMERICA PKWY STE 320
SANTA CLARA CA
95054-1140
US

IV. Provider business mailing address

521 BAILEY LOOP RD
GARDENDALE AL
35071-3212
US

V. Phone/Fax

Practice location:
  • Phone: 323-205-7088
  • Fax:
Mailing address:
  • Phone: 205-422-0484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number121298
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberL657
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: