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NPI Code Detail

MEDICARE: MS. CAROLYN B KELLOGG MFT

MEDICARE: MS. CAROLYN B KELLOGG MFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistMFC 27890CA

General Provider Information

NPI Number : 1174542112
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CAROLYN B KELLOGG MFT
Provider Business Mailing Address
First Line : 626 BALBOA ST
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94118-3725
Country : US
Telephone Number : 415-221-2838
Fax Number : 415-388-4844
Provider Business Practice Location Address
First Line : 626 BALBOA ST
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94118-3725
Country : US
Telephone Number : 415-221-2838
Fax Number : 415-388-4844
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2006
Last Update Date : 07/08/2007

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