Provider Demographics
NPI:1053461228
Name:CANELO, CHRISTINE MARIE (MFT)
Entity Type:Individual
Prefix:MISS
First Name:CHRISTINE
Middle Name:MARIE
Last Name:CANELO
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 1:7300 WYNDHAM DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-4913
Mailing Address - Country:US
Mailing Address - Phone:916-525-6100
Mailing Address - Fax:
Practice Address - Street 1:7300 WYNDHAM DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-4913
Practice Address - Country:US
Practice Address - Phone:916-525-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAME 23866101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health