Provider Demographics
NPI:1194092874
Name:SOLANO, KATHLEEN REBECCA (MS, LMFT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:REBECCA
Last Name:SOLANO
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1357 W SHAW AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-3618
Mailing Address - Country:US
Mailing Address - Phone:559-475-0854
Mailing Address - Fax:559-492-2537
Practice Address - Street 1:1357 W SHAW AVE STE 106
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3618
Practice Address - Country:US
Practice Address - Phone:559-475-0854
Practice Address - Fax:559-492-2537
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 49370106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist