Provider Demographics
NPI:1891326732
Name:KAGEL, LYDIA CARLTON TURNER (AMFT)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:CARLTON TURNER
Last Name:KAGEL
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:
Other - Last Name:KAGEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AMFT
Mailing Address - Street 1:PO BOX 1053
Mailing Address - Street 2:
Mailing Address - City:GEYSERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95441-1053
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3436 MENDOCINO AVE STE B
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-2180
Practice Address - Country:US
Practice Address - Phone:707-200-4211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT110436106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist