Provider Demographics
NPI:1205103082
Name:KATZ, JASON (LPCC, LMFT)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:KATZ
Suffix:
Gender:M
Credentials:LPCC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3158 N ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-6515
Mailing Address - Country:US
Mailing Address - Phone:213-359-3839
Mailing Address - Fax:
Practice Address - Street 1:2308 J ST STE D
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-4718
Practice Address - Country:US
Practice Address - Phone:213-359-3839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-22
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60064964101YM0800X
CALMFT 83803106H00000X
CALPCC 162101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional