# KATHLEEN CARLSON MFT INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114132065
- **Authorized official:** KATHLEEN CARLSON MFT (CEO)
- **Authorized official phone:** (650) 619-1198

## Contact information

- **Practice address:** 1710 S AMPHLETT BLVD STE 210H, SAN MATEO, CA 94402-2705
- **Practice address phone:** (650) 619-1198
- **Mailing address:** 1710 S AMPHLETT BLVD, \#210H, SAN MATEO, CA 94402-2703
- **Mailing address phone:** (650) 619-1198

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 106H00000X | Marriage & Family Therapist | 17742 | CA | Yes |

## Other

- **Enumeration date:** 05/14/2007
- **Last updated:** 04/06/2017