Provider Demographics
NPI:1679761977
Name:CLARKE PELTON, KATHLEEN (MA, LMFT, LPC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:CLARKE PELTON
Suffix:
Gender:F
Credentials:MA, LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:994 MORTON ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-3151
Mailing Address - Country:US
Mailing Address - Phone:541-552-9797
Mailing Address - Fax:
Practice Address - Street 1:565 A ST
Practice Address - Street 2:SUITE 203
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-2063
Practice Address - Country:US
Practice Address - Phone:541-552-9797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1616101YM0800X
CAMFC33224106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist