Provider Demographics
NPI:1063538254
Name:JONES-LORENZ, KATHI (PHD)
Entity type:Individual
Prefix:DR
First Name:KATHI
Middle Name:
Last Name:JONES-LORENZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1891 E ROSEVILLE PKWY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-7973
Mailing Address - Country:US
Mailing Address - Phone:916-774-6000
Mailing Address - Fax:916-774-6018
Practice Address - Street 1:1891 E ROSEVILLE PKWY
Practice Address - Street 2:SUITE 120
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-7973
Practice Address - Country:US
Practice Address - Phone:916-774-6000
Practice Address - Fax:916-774-6018
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2014-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13218103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL132180Medicare ID - Type Unspecified