Provider Demographics
NPI:1427275536
Name:KLOKOW, MYRNA JEAN (MA, MFT)
Entity type:Individual
Prefix:MRS
First Name:MYRNA
Middle Name:JEAN
Last Name:KLOKOW
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 W FREMONT AVE STE 9E
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-4200
Mailing Address - Country:US
Mailing Address - Phone:408-738-8708
Mailing Address - Fax:408-738-8708
Practice Address - Street 1:690 W FREMONT AVE STE 9E
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-4200
Practice Address - Country:US
Practice Address - Phone:408-738-8708
Practice Address - Fax:408-738-8708
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC29594106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist