Provider Demographics
NPI:1629559802
Name:SKT THERAPY INC
Entity Type:Organization
Organization Name:SKT THERAPY INC
Other - Org Name:SKT THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:KLOSAK
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:650-252-0300
Mailing Address - Street 1:765 N MAIN ST STE 130-A10
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92878-1440
Mailing Address - Country:US
Mailing Address - Phone:650-252-0300
Mailing Address - Fax:951-735-7113
Practice Address - Street 1:765 N MAIN ST STE 130-A10
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92878-1440
Practice Address - Country:US
Practice Address - Phone:650-252-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-24
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA93637106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty