Provider Demographics
NPI:1134308463
Name:KESSELRING, ROBERT ALAN (MA, LPC, MFTI)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ALAN
Last Name:KESSELRING
Suffix:
Gender:M
Credentials:MA, LPC, MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 221096
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822-8096
Mailing Address - Country:US
Mailing Address - Phone:734-255-4485
Mailing Address - Fax:
Practice Address - Street 1:1500 NORTH A STREET
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95814-0712
Practice Address - Country:US
Practice Address - Phone:916-440-1500
Practice Address - Fax:916-440-1514
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-02
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009133101YM0800X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA63176OtherMARRIAGE AND FAMILY THERAPIST INTERN