Provider Demographics
NPI:1720296197
Name:EISGRAU, MALKA RHONDA (LPC, LPN)
Entity type:Individual
Prefix:MS
First Name:MALKA
Middle Name:RHONDA
Last Name:EISGRAU
Suffix:
Gender:F
Credentials:LPC, LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11221 LOCH LOMOND RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CA
Mailing Address - Zip Code:95461-9739
Mailing Address - Country:US
Mailing Address - Phone:707-928-0190
Mailing Address - Fax:
Practice Address - Street 1:15145A LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:CLEARLAKE
Practice Address - State:CA
Practice Address - Zip Code:95422-8106
Practice Address - Country:US
Practice Address - Phone:707-994-7090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC 947101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health