1841549979 NPI number — MRS. KARIE L KLIM MFT

Table of content: MRS. KARIE L KLIM MFT (NPI 1841549979)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841549979 NPI number — MRS. KARIE L KLIM MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLIM
Provider First Name:
KARIE
Provider Middle Name:
L
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THULON
Provider Other First Name:
KARIE
Provider Other Middle Name:
LOUISE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMFT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1841549979
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 367
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT MARIES
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83861-0367
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-888-0106
Provider Business Mailing Address Fax Number:
707-539-8890

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
170 FARMERS LANE SUITE 6B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA ROSA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95405-4773
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-888-0106
Provider Business Practice Location Address Fax Number:
707-539-8890
Provider Enumeration Date:
09/05/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  LMFT-8721 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: MFC101425 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 106H00000X , with the licence number: 101425 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)