Provider Demographics
NPI:1942671615
Name:WAHLIN, KARA LUDMILLA (MA)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:LUDMILLA
Last Name:WAHLIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74075 EL PASEO STE A2A
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-4118
Mailing Address - Country:US
Mailing Address - Phone:650-308-4188
Mailing Address - Fax:760-568-6175
Practice Address - Street 1:74075 EL PASEO STE A2A
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-4118
Practice Address - Country:US
Practice Address - Phone:650-308-4188
Practice Address - Fax:760-568-6175
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53003106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist