Provider Demographics
NPI:1386677847
Name:AYMETT, KATHLEEN DANETTE (MA,MFT)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:DANETTE
Last Name:AYMETT
Suffix:
Gender:F
Credentials:MA,MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9521 FOLSOM BLVD
Mailing Address - Street 2:STE R
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-1203
Mailing Address - Country:US
Mailing Address - Phone:916-368-8867
Mailing Address - Fax:
Practice Address - Street 1:9521 FOLSOM BLVD
Practice Address - Street 2:STE R
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-1203
Practice Address - Country:US
Practice Address - Phone:916-368-8867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC20874106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ12613ZMedicare UPIN