Provider Demographics
NPI:1497381545
Name:CHELTON, KATHARINE CHALMERS
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:CHALMERS
Last Name:CHELTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7765 HEALDSBURG AVE STE 12
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-3355
Mailing Address - Country:US
Mailing Address - Phone:707-823-8203
Mailing Address - Fax:
Practice Address - Street 1:7765 HEALDSBURG AVE STE 12
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-3355
Practice Address - Country:US
Practice Address - Phone:707-823-8203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-20
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT30322101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health