Provider Demographics
NPI:1083820591
Name:KLEMENZ, NORA JANE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:NORA
Middle Name:JANE
Last Name:KLEMENZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4817 PALM AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-3861
Mailing Address - Country:US
Mailing Address - Phone:619-994-5989
Mailing Address - Fax:
Practice Address - Street 1:4817 PALM AVE
Practice Address - Street 2:SUITE G
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-3861
Practice Address - Country:US
Practice Address - Phone:619-994-5989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 40808106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist