Provider Demographics
NPI:1912483983
Name:BOBO, KATRINA MARY (IMFT 97106, PCCI 354)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:MARY
Last Name:BOBO
Suffix:
Gender:F
Credentials:IMFT 97106, PCCI 354
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:MARY
Other - Last Name:SPRAGGINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:521 BAILEY LOOP RD
Mailing Address - Street 2:
Mailing Address - City:GARDENDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35071-3212
Mailing Address - Country:US
Mailing Address - Phone:205-422-0484
Mailing Address - Fax:
Practice Address - Street 1:5201 GREAT AMERICA PKWY STE 320
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95054-1140
Practice Address - Country:US
Practice Address - Phone:323-205-7088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA121298101YM0800X
ALL657101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health