Provider Demographics
NPI:1720361967
Name:MUNOZ, KATHERINE MARIE
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARIE
Last Name:MUNOZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:MARIE
Other - Last Name:GUERRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1133 COLOMA WAY STE C
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4480
Mailing Address - Country:US
Mailing Address - Phone:916-774-6647
Mailing Address - Fax:916-774-6456
Practice Address - Street 1:1133 COLOMA WAY STE C
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661
Practice Address - Country:US
Practice Address - Phone:916-774-6647
Practice Address - Fax:916-774-6456
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist