Provider Demographics
NPI:1003980251
Name:MCPHERSON, KONIKA ROSENBAUM (MFTI)
Entity Type:Individual
Prefix:
First Name:KONIKA
Middle Name:ROSENBAUM
Last Name:MCPHERSON
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:KONIKA
Other - Middle Name:ROSENBAUM
Other - Last Name:MCPHERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:101 NORTH MAIN ST
Mailing Address - Street 2:1776
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465
Mailing Address - Country:US
Mailing Address - Phone:805-369-1574
Mailing Address - Fax:
Practice Address - Street 1:2180 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4558
Practice Address - Country:US
Practice Address - Phone:805-781-4865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA65416106H00000X
CA97137106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health