MEDICARE: CHICO AFFIRMATIVE THERAPY A LICENSED MARRIAGE AND FAMILY THERA

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
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1437902053
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHICO AFFIRMATIVE THERAPY A LICENSED MARRIAGE AND FAMILY THERA

Provider Business Mailing Address
First Line	:	PO BOX 6939
Second Line	:
City	:	CHICO
State	:	CA
Zip	:	95927-6939
Country	:	US
Telephone Number	:	530-361-5303
Fax Number	:	530-255-2152

Provider Business Practice Location Address
First Line	:	669 PALMETTO AVE STE A
Second Line	:
City	:	CHICO
State	:	CA
Zip	:	95926-4065
Country	:	US
Telephone Number	:	530-361-5303
Fax Number	:	530-255-2152

Authorized Official
Title or Position	:	DIRECTOR/OWNER
Name	:	KATHLEEN DAHLSTROM
Credential	:	LMFT
Telephone Number	:	530-361-5303

Provider Enumeration Date	:	04/11/2024
Last Update Date	:	04/06/2026

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