Basic Information
| Provider Information | |||||||||
| NPI: | 1861585788 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAWSON | ||||||||
| FirstName: | KIM | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6615 VALLEY HI DRIVE SUITE A | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9166816300 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6615 VALLEY HI DR., SUITE A | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9166816300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 04/18/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 50272 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | MFC 51332 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | 106H00000X | 01 | CA | MEDI-CAL | OTHER |