Healthcare Provider Details

I. General information

NPI: 1043538499
Provider Name (Legal Business Name): KATHY MAE EKREN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2010
Last Update Date: 11/24/2023
Certification Date: 11/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3558 ROUND BARN BLVD STE 200
SANTA ROSA CA
95403-0991
US

IV. Provider business mailing address

3558 ROUND BARN BLVD STE 200
SANTA ROSA CA
95403-0991
US

V. Phone/Fax

Practice location:
  • Phone: 707-843-7887
  • Fax:
Mailing address:
  • Phone: 707-843-7887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number60444728
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number94889
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: