Provider Demographics
NPI:1265526958
Name:RICE, KHARA ELISE (MA, MFT)
Entity type:Individual
Prefix:MRS
First Name:KHARA
Middle Name:ELISE
Last Name:RICE
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:MISS
Other - First Name:KHARA
Other - Middle Name:ELISE
Other - Last Name:FIELDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:4470 BRISBANE WAY
Mailing Address - Street 2:#2
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-0639
Mailing Address - Country:US
Mailing Address - Phone:760-722-3981
Mailing Address - Fax:
Practice Address - Street 1:4241 JUTLAND DR
Practice Address - Street 2:SUITE 202
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-3663
Practice Address - Country:US
Practice Address - Phone:858-274-6633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 43610106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist