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NPI Code Detail

MEDICARE: KELLY L KARTUB MFT

MEDICARE: KELLY L KARTUB 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 34766CA

General Provider Information

NPI Number : 1891833653
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY L KARTUB MFT
Provider Business Mailing Address
First Line : 7931 UVA DR
Second Line :
City : REDWOOD VALLEY
State : CA
Zip : 95470-9621
Country : US
Telephone Number : 707-472-2922
Fax Number :
Provider Business Practice Location Address
First Line : 350 E GOBBI ST
Second Line :
City : UKIAH
State : CA
Zip : 95482-5511
Country : US
Telephone Number : 707-472-2922
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2007
Last Update Date : 02/10/2011

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Directions to “ KELLY L KARTUB MFT” Practice Location

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