Provider Demographics
NPI:1356007975
Name:WELLNESS FOR HUMANITY MARRIAGE AND FAMILY THERAPY PC
Entity Type:Organization
Organization Name:WELLNESS FOR HUMANITY MARRIAGE AND FAMILY THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KALENE
Authorized Official - Middle Name:N
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:401-236-7206
Mailing Address - Street 1:417 SEATON DR
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-7951
Mailing Address - Country:US
Mailing Address - Phone:916-300-2624
Mailing Address - Fax:
Practice Address - Street 1:2717 COTTAGE WAY STE 6
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-1233
Practice Address - Country:US
Practice Address - Phone:401-236-7206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty