Provider Demographics
NPI:1841324472
Name:KEM, KOLTHIDA NONE (BA)
Entity type:Individual
Prefix:
First Name:KOLTHIDA
Middle Name:NONE
Last Name:KEM
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 E SHAW AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-8105
Mailing Address - Country:US
Mailing Address - Phone:559-248-8550
Mailing Address - Fax:559-248-8555
Practice Address - Street 1:1630 E SHAW AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-8105
Practice Address - Country:US
Practice Address - Phone:559-248-8550
Practice Address - Fax:559-248-8555
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health