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Kathy Mae Ekren

Marriage & Family Therapist

Behavioral Health & Social Service Providers

3558 Round Barn Blvd Ste 200, Santa Rosa, CA 95403-0991

PECOS Enrollment

This provider is enrolled in PECOS as KATHY EKREN.

Based on the most recent information from CMS, provider Kathy Mae Ekren is legally eligible to order and refer claims for Part B and DME services only.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 1:08 PM.

Profile Details

Provider ID
1043538499
Provider Type
Individual
Full Name
Ekren, Kathy Mae
Credential
LMFT

Gender
Female
Sole Proprietor
Yes
Enumeration Date
5/10/2010
Last Updated
11/24/2023

Contact Information

Practice Location

3558 Round Barn Blvd Ste 200, Santa Rosa, CA 95403-0991

(707) 843-7887

Unlisted Fax

Mailing Location

3558 Round Barn Blvd Ste 200, Santa Rosa, CA 95403-0991

(707) 843-7887

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 106H00000X Primary	Description Marriage & Family Therapist Behavioral Health & Social Service Providers	License 94889 California
Code 101YM0800X	Description Counselor Behavioral Health & Social Service Providers	License 60444728 Washington

Provider Identifiers

ID	Description	Issuer
ID 3719942	Description Medicaid	Issuer Unlisted California
ID 94889	Description Other	Issuer BOARD OF BEHAVIORAL SCIENCES California

Kathy Mae Ekren

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Provider Identifiers

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Description

Issuer

ID

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ID

Description

Issuer

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