Provider Demographics
NPI:1033120415
Name:KELZER, CHARLENE KOHL (MA)
Entity Type:Individual
Prefix:MRS
First Name:CHARLENE
Middle Name:KOHL
Last Name:KELZER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 SHON COURT
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-4819
Mailing Address - Country:US
Mailing Address - Phone:415-883-4360
Mailing Address - Fax:415-883-4360
Practice Address - Street 1:9 SHON COURT
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-4819
Practice Address - Country:US
Practice Address - Phone:415-883-4360
Practice Address - Fax:415-883-4360
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT15386106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist