Provider Demographics
NPI:1215136270
Name:HOLMGREN, KATHLEEN ANDREA (MFT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANDREA
Last Name:HOLMGREN
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 1:1105 IRONWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94502-6620
Mailing Address - Country:US
Mailing Address - Phone:510-919-7905
Mailing Address - Fax:510-864-8072
Practice Address - Street 1:883 ISLAND DR
Practice Address - Street 2:SUITE 207
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94502-6798
Practice Address - Country:US
Practice Address - Phone:510-919-7905
Practice Address - Fax:510-864-8072
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 22257106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist