Provider Demographics
NPI:1760632020
Name:RIETTA-WONG, KATHLEEN (MA MFT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:RIETTA-WONG
Suffix:
Gender:F
Credentials:MA MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 PYRAMID WAY
Mailing Address - Street 2:SUITE # 402
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-4494
Mailing Address - Country:US
Mailing Address - Phone:775-741-9555
Mailing Address - Fax:
Practice Address - Street 1:1001 PYRAMID WAY
Practice Address - Street 2:SUITE # 402
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-4494
Practice Address - Country:US
Practice Address - Phone:775-741-9555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01088106H00000X
CA34069106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist