Provider Demographics
NPI:1881239333
Name:KJELDSEN, DEBORAH (LMFT)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:KJELDSEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3604 TROY DALTON ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5659
Mailing Address - Country:US
Mailing Address - Phone:415-992-2710
Mailing Address - Fax:
Practice Address - Street 1:1731 I ST STE 202
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-3001
Practice Address - Country:US
Practice Address - Phone:415-992-2710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-08
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA97129106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist