Provider Demographics
NPI:1447067194
Name:KOHLS, ANA-LUISA HORAK (MA, EDS, PPS)
Entity type:Individual
Prefix:
First Name:ANA-LUISA
Middle Name:HORAK
Last Name:KOHLS
Suffix:
Gender:F
Credentials:MA, EDS, PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:CLOVERDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95425-3244
Mailing Address - Country:US
Mailing Address - Phone:707-894-1903
Mailing Address - Fax:
Practice Address - Street 1:97 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:CLOVERDALE
Practice Address - State:CA
Practice Address - Zip Code:95425-3244
Practice Address - Country:US
Practice Address - Phone:760-894-1903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty