Provider Demographics
NPI:1225412679
Name:FLACH, KADE (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:KADE
Middle Name:
Last Name:FLACH
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:GRACE
Other - Last Name:FLACH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LMFT
Mailing Address - Street 1:PO BOX 110334
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95011-0334
Mailing Address - Country:US
Mailing Address - Phone:415-841-3338
Mailing Address - Fax:
Practice Address - Street 1:137 E HAMILTON AVE STE 205
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-0244
Practice Address - Country:US
Practice Address - Phone:415-841-3338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-15
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT106366106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALMFT106366OtherLICENSE #