Provider Demographics
NPI:1982193280
Name:LOR THAO, KATHY PAKUE (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:PAKUE
Last Name:LOR THAO
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:SOFIAH
Other - Middle Name:PAKUE
Other - Last Name:LOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, BCBA
Mailing Address - Street 1:2717 COTTAGE WAY STE 16
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-1222
Mailing Address - Country:US
Mailing Address - Phone:916-913-1542
Mailing Address - Fax:
Practice Address - Street 1:2717 COTTAGE WAY STE 16
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-1222
Practice Address - Country:US
Practice Address - Phone:916-913-1542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-02
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1-22-59395103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst