Healthcare Provider Details

I. General information

NPI: 1861530677
Provider Name (Legal Business Name): KIM A ABELSON MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 02/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9860 MIDDLE CREEK RD
UPPER LAKE CA
95485-9265
US

IV. Provider business mailing address

237 E GOBBI ST
UKIAH CA
95482-5551
US

V. Phone/Fax

Practice location:
  • Phone: 707-275-8166
  • Fax: 707-275-8168
Mailing address:
  • Phone: 707-472-2922
  • Fax: 707-462-1381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 42971
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: