Provider Demographics
NPI:1568622090
Name:SPRIGGS-BALLESTERO, KATHLEEN MARIE (LICENSED MARRIAGE FA)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:MARIE
Last Name:SPRIGGS-BALLESTERO
Suffix:
Gender:F
Credentials:LICENSED MARRIAGE FA
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:MARIE
Other - Last Name:SPRIGGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:HOUSE PSYCHIATRIC GROUP, INC.
Mailing Address - Street 2:1322 E. SHAW #410
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-7904
Mailing Address - Country:US
Mailing Address - Phone:559-226-1316
Mailing Address - Fax:559-226-1315
Practice Address - Street 1:HOUSE PSYCHIATRIC GROUP, INC.
Practice Address - Street 2:1322 E. SHAW #410
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-7904
Practice Address - Country:US
Practice Address - Phone:559-226-1316
Practice Address - Fax:559-226-1315
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC44879106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist