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General NPI Number Information
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NPI Number | 1912483983
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Entity Type | Individual
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Provider Name | KATRINA MARY BOBO IMFT 97106, PCCI 354
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Gender | Female
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Dates
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Enumeration Date | 07/12/2018
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Last Update Date | 07/24/2024
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Provider Practice Location Address
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Address Line | 5201 GREAT AMERICA PKWY STE 320
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City | SANTA CLARA
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State | CA
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Zip | 95054-1140
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Country | US
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Telephone | 323-205-7088
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Fax |
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Provider Business Mailing Address
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Address Line | 521 BAILEY LOOP RD
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City | GARDENDALE
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State | AL
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Zip | 35071-3212
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Country | US
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Telephone | 205-422-0484
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 121298
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | L657
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License Number State | AL
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