Healthcare Provider Details

I. General information

NPI: 1902457260
Provider Name (Legal Business Name): KATHRIN WINKLER THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2019
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 BRISTOL ST STE J206
COSTA MESA CA
92626-7921
US

IV. Provider business mailing address

1835 NEWPORT BLVD STE A109
COSTA MESA CA
92627-5007
US

V. Phone/Fax

Practice location:
  • Phone: 949-436-7364
  • Fax:
Mailing address:
  • Phone: 949-436-7364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: KATHRIN WINKLER
Title or Position: CEO
Credential: LMFT
Phone: 949-436-7364