Provider Demographics
NPI:1407585110
Name:BOAS, KALEB (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:KALEB
Middle Name:
Last Name:BOAS
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 ESPLANADE CIR
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-7351
Mailing Address - Country:US
Mailing Address - Phone:530-363-8898
Mailing Address - Fax:
Practice Address - Street 1:102 ESPLANADE CIR
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-7351
Practice Address - Country:US
Practice Address - Phone:530-363-8898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA129019106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist