Provider Demographics
NPI:1104112069
Name:CHRISTENSON SCHWARTZ, KATHLEEN MARIE (MFT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARIE
Last Name:CHRISTENSON SCHWARTZ
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3976
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:CA
Mailing Address - Zip Code:95971-3976
Mailing Address - Country:US
Mailing Address - Phone:530-283-9370
Mailing Address - Fax:
Practice Address - Street 1:2056 E MAIN ST
Practice Address - Street 2:SUITE #3
Practice Address - City:QUINCY
Practice Address - State:CA
Practice Address - Zip Code:95971-9658
Practice Address - Country:US
Practice Address - Phone:530-283-9370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 49602106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
45-3554133OtherIRS