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General NPI Number Information
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NPI Number | 1114132065
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Entity Type | Organization
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Legal Business Name | KATHLEEN CARLSON MFT INC
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 04/06/2017
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Provider Practice Location Address
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Address Line | 1710 S AMPHLETT BLVD STE 210H
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City | SAN MATEO
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State | CA
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Zip | 94402-2705
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Country | US
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Telephone | 650-619-1198
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Fax |
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Provider Business Mailing Address
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Address Line | 1710 S AMPHLETT BLVD #210H
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City | SAN MATEO
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State | CA
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Zip | 94402-2703
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Country | US
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Telephone | 650-619-1198
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KATHLEEN CARLSON
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Credential | MFT
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Telephone | 650-619-1198
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 17742
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License Number State | CA
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