KHRAYTHONG SOUPHOLPHAKDY (NPI# 1891902342) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891902342 |
| Entity Type | Individual |
| Full Name | KHRAYTHONG SOUPHOLPHAKDY |
| Practice Address |
1221 Farmers Ln Suite B Santa Rosa CA 95405-6712 |
| Mailing Address |
1221 Farmers Ln Santa Rosa CA 95405-6712 |
| Practice Telephone | 7075656953 |
| Mailing Telephone | 7075656953 |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2014-08-25 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers |
| Street Address |
1221 FARMERS LN SUITE B |
| City | SANTA ROSA |
| State | CA |
| Zip Code | 95405-6712 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235199373 | Ronald J Botelho | Anesthesiology | 1221 Farmers Ln, Suite 500, Santa Rosa, CA 95405-6712 | 2006-03-24 |
| 1982942637 | Heather Christensen | Physical Therapist | 1221 Farmers Ln, Ste B, Santa Rosa, CA 95405-6712 | 2013-01-30 |
| 1043576465 | At Your Service Home Care | Custodial Care Facility | 1221 Farmers Ln, Suite A, Santa Rosa, CA 95405-6712 | 2012-04-10 |
| 1558627315 | Catherine Lynn Hes | Physical Therapist | 1221 Farmers Ln, Santa Rosa, CA 95405-6712 | 2012-04-05 |
| 1336471085 | Ronald J. Botelho, Md, Ltd | Anesthesiology | 1221 Farmers Ln, Suite 500, Santa Rosa, CA 95405-6712 | 2010-02-05 |
| 1962615302 | Edward Peter Campbell | Counselor | 1221 Farmers Ln, Santa Rosa, CA 95405-6712 | 2007-05-08 |
| 1184772725 | Michael A. Ulloa | Social Worker | 1221 Farmers Ln, Santa Rosa, CA 95405-6712 | 2007-01-08 |
| 1427106939 | Catherine A Wesley | Registered Nurse | 1221 Farmers Ln, Suite A, Santa Rosa, CA 95405-6712 | 2007-01-08 |
| 1689736779 | Michael E. Kee | Counselor | 1221 Farmers Ln, Santa Rosa, CA 95405-6712 | 2006-12-14 |
| 1811904501 | Physiotherapy Associates Inc | Clinic/Center | 1221 Farmers Ln, Ste B, Santa Rosa, CA 95405-6712 | 2006-08-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083230486 | Lizett Camacho | Counselor | 145o Neotomas Avenue Suite 200, Santa Rosa, CA 95405 | 2020-06-22 |
| 1346768918 | Ingrid Tsong | Student in an Organized Health Care Education/Training Program | 3447 Summerfield Road, Santa Rosa, CA 95405 | 2017-09-05 |
| 1275051898 | Jessica Peters Malmberg | Student in an Organized Health Care Education/Training Program | 2447 Summerfield Rd, Santa Rosa, CA 95405 | 2017-09-04 |
| 1306246772 | Kirsten Eckert | Advanced Practice Midwife | 500 Doyle Park Dr Suite 103, Santa Rosa, CA 95405 | 2014-09-03 |
| 1982034294 | Mohammad Reza Saeidi | Dentist | 1820 Sonoma Ave Ste 90a, Santa Rosa, CA 95405 | 2013-11-22 |
| 1851631642 | Debi M. Emmons | Marriage & Family Therapist | 2447 Summerfield Dr, Social Advocates for Youth, Santa Rosa, CA 95405 | 2013-02-15 |
| 1841549979 | Karie Louise Klim | Marriage & Family Therapist | 182 Farmers Ln Ste 204, Santa Rosa, CA 95405 | 2012-09-05 |
| 1427314400 | Rachel E. Page | Counselor | 2447 Summerfield Rd., Santa Rosa, CA 95405 | 2012-04-04 |
| 1689991572 | Center for Integral Healing Inc. | Community Health Worker | 182 Farmers Lane, #203, Santa Rosa, CA 95405 | 2010-04-30 |
| 1588997647 | Kai Morgan | Dentist | 1144 Suite 116 Soonoma Ave, Santa Rosa, CA 95405 | 2009-09-08 |
| Find all providers in zip 95405 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205442217 | David Lee Dutton | Counselor | 201 S. E Street, Santa Rosa, CA 95404 | 2020-09-16 |
| 1730710260 | Harold Joseph Bahr | Counselor | 1550 N Dutton Ave, Santa Rosa, CA 95401-4601 | 2020-02-03 |
| 1801432398 | William Carroll | Counselor | 1260 N Dutton Ave Ste 185, Santa Rosa, CA 95401-7146 | 2019-11-20 |
| 1497390462 | Emily Sue Hamp | Counselor | 1202 Woodlake Dr, Santa Rosa, CA 95405-9217 | 2019-11-13 |
| 1316410640 | Lionel C Cooper | Counselor | 315 Mark West Springs Road, Santa Rosa, CA 95403 | 2019-01-09 |
| 1174005540 | Amal Saeed Ahmed | Counselor | 2908 Bay Village Cir Apt 2108, Santa Rosa, CA 95403-3611 | 2018-09-03 |
| 1114436060 | Lacey Lynn Palmer | Counselor | 341 Irwin Lane, Santa Rosa, CA 95401 | 2017-09-22 |
| 1992223192 | Jill Mcculloch | Counselor | 300 Stony Point Rd Apt 190, Santa Rosa, CA 95401-5960 | 2017-09-07 |
| 1497299325 | Janice Anne Myers | Counselor | 3746 Oregon Dr, Santa Rosa, CA 95405-7136 | 2016-12-12 |
| 1689128001 | Wakanda Rose | Counselor | 254 Brey Rd, Santa Rosa, CA 95409-5556 | 2016-08-15 |
| Find all providers in SANTA ROSA | ||||
| City | SANTA ROSA |
| Zip Code | 95405 |
Please comment or provide details below to improve the information on KHRAYTHONG SOUPHOLPHAKDY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.