Provider Demographics
NPI:1669664272
Name:KLASSEN, MYRNA L (MFT)
Entity Type:Individual
Prefix:MS
First Name:MYRNA
Middle Name:L
Last Name:KLASSEN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2339 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94127-2605
Mailing Address - Country:US
Mailing Address - Phone:415-764-0252
Mailing Address - Fax:415-641-1114
Practice Address - Street 1:2339 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94127-2605
Practice Address - Country:US
Practice Address - Phone:415-764-0252
Practice Address - Fax:415-641-1114
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT23996106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist