Provider Demographics
NPI:1164226429
Name:SALCEDO, KEUMBI GEONNA (MA,)
Entity type:Individual
Prefix:
First Name:KEUMBI
Middle Name:GEONNA
Last Name:SALCEDO
Suffix:
Gender:F
Credentials:MA,
Other - Prefix:
Other - First Name:KEUMBI
Other - Middle Name:
Other - Last Name:YUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1168 BEELARD DR
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-5544
Mailing Address - Country:US
Mailing Address - Phone:707-689-4972
Mailing Address - Fax:
Practice Address - Street 1:850 MERCHANT ST
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-6900
Practice Address - Country:US
Practice Address - Phone:707-446-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT152862101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor