Provider Demographics
NPI:1396157061
Name:BOKLUND, MARIA CLAIRE (LMFT)
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:CLAIRE
Last Name:BOKLUND
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:MARIA
Other - Middle Name:CLAIRE
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:2 S GREEN ST
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-4618
Mailing Address - Country:US
Mailing Address - Phone:408-202-8497
Mailing Address - Fax:209-588-9563
Practice Address - Street 1:105 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5227
Practice Address - Country:US
Practice Address - Phone:408-533-6245
Practice Address - Fax:209-588-9563
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 48496106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist