Provider Demographics
NPI:1073780060
Name:KROW, BEILA (MFT)
Entity Type:Individual
Prefix:MS
First Name:BEILA
Middle Name:
Last Name:KROW
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MRS
Other - First Name:BEILA
Other - Middle Name:KROW
Other - Last Name:RODIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT
Mailing Address - Street 1:PO BOX 935
Mailing Address - Street 2:
Mailing Address - City:SOQUEL
Mailing Address - State:CA
Mailing Address - Zip Code:95073-0935
Mailing Address - Country:US
Mailing Address - Phone:831-477-1232
Mailing Address - Fax:831-477-1232
Practice Address - Street 1:4141 FAIRWAY DRIVE
Practice Address - Street 2:
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-3002
Practice Address - Country:US
Practice Address - Phone:831-477-1232
Practice Address - Fax:831-477-1232
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-09
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT25627106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist