Provider Demographics
NPI:1265633572
Name:SKOGLUND, KAMRY ELAYNE (MFT)
Entity Type:Individual
Prefix:
First Name:KAMRY
Middle Name:ELAYNE
Last Name:SKOGLUND
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 1:850 SAFFRON DR
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95377-8669
Mailing Address - Country:US
Mailing Address - Phone:510-299-4792
Mailing Address - Fax:
Practice Address - Street 1:9 W 8TH ST
Practice Address - Street 2:700
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-4122
Practice Address - Country:US
Practice Address - Phone:510-299-4792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC39879106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist