Healthcare Provider Details

I. General information

NPI: 1891833653
Provider Name (Legal Business Name): KELLY L KARTUB MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY L MCCLUNG

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 02/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 E GOBBI ST
UKIAH CA
95482-5511
US

IV. Provider business mailing address

7931 UVA DR
REDWOOD VALLEY CA
95470-9621
US

V. Phone/Fax

Practice location:
  • Phone: 707-472-2922
  • Fax:
Mailing address:
  • Phone: 707-472-2922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 34766
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: