Provider Demographics
NPI:1992909089
Name:CLARSTROM, MARGARET ELLEN (MFT)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:ELLEN
Last Name:CLARSTROM
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1670 WILD CANARY ST
Mailing Address - Street 2:
Mailing Address - City:MCKINLEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95519-4076
Mailing Address - Country:US
Mailing Address - Phone:707-840-0931
Mailing Address - Fax:
Practice Address - Street 1:935 3RD ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-0513
Practice Address - Country:US
Practice Address - Phone:707-444-8895
Practice Address - Fax:707-444-0220
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC42423106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist