Healthcare Provider Details

I. General information

NPI: 1942867387
Provider Name (Legal Business Name): KATELYN ELIZABETH FIKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2019
Last Update Date: 09/18/2021
Certification Date: 09/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5619 N FIGUEROA ST APT 228
HIGHLAND PARK CA
90042-4979
US

IV. Provider business mailing address

5619 N FIGUEROA ST APT 228
HIGHLAND PARK CA
90042-4979
US

V. Phone/Fax

Practice location:
  • Phone: 818-396-7774
  • Fax:
Mailing address:
  • Phone: 818-396-7774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT120927
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: