Provider Demographics
NPI:1659594141
Name:KATZ, KENNETH I (LCSW, CTS)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:I
Last Name:KATZ
Suffix:
Gender:M
Credentials:LCSW, CTS
Other - Prefix:
Other - First Name:KEN
Other - Middle Name:
Other - Last Name:KATZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW, CTS
Mailing Address - Street 1:1194 LOS ALTOS AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-0456
Mailing Address - Country:US
Mailing Address - Phone:559-349-0238
Mailing Address - Fax:559-297-7642
Practice Address - Street 1:6235 N FRESNO ST
Practice Address - Street 2:SUITE 101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5269
Practice Address - Country:US
Practice Address - Phone:559-349-0238
Practice Address - Fax:559-297-7642
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 123311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical