Provider Demographics
NPI:1780862144
Name:KESLER, NICOLE LOUISE (LMFT, MA)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:LOUISE
Last Name:KESLER
Suffix:
Gender:F
Credentials:LMFT, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2378 MARITIME DRIVE
Mailing Address - Street 2:SUITE #100
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758
Mailing Address - Country:US
Mailing Address - Phone:916-627-2252
Mailing Address - Fax:
Practice Address - Street 1:2378 MARITIME DRIVE
Practice Address - Street 2:SUITE #100 FAMILY MATTERS COUNSELING
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758
Practice Address - Country:US
Practice Address - Phone:916-627-2252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 37098106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA010434Medicaid