Healthcare Provider Details

I. General information

NPI: 1225589500
Provider Name (Legal Business Name): KAITLYN ROSE MARSH LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2016
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 BEACON BLVD STE 200A
WEST SACRAMENTO CA
95691-3467
US

IV. Provider business mailing address

3050 BEACON BLVD
WEST SACRAMENTO CA
95691-3467
US

V. Phone/Fax

Practice location:
  • Phone: 530-264-6224
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number96898
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number122146
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: