Provider Demographics
NPI:1831308402
Name:KOHLENBERGER, NANCIE (MFT)
Entity Type:Individual
Prefix:MS
First Name:NANCIE
Middle Name:
Last Name:KOHLENBERGER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:NANCIE
Other - Middle Name:
Other - Last Name:CHEPPO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:1000 QUAIL ST
Mailing Address - Street 2:STE. 175
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2731
Mailing Address - Country:US
Mailing Address - Phone:949-922-8548
Mailing Address - Fax:888-722-4292
Practice Address - Street 1:1000 QUAIL ST
Practice Address - Street 2:SUITE 175
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2731
Practice Address - Country:US
Practice Address - Phone:949-922-8548
Practice Address - Fax:888-722-4292
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT39360106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist