Healthcare Provider Details

I. General information

NPI: 1932789161
Provider Name (Legal Business Name): KATE KUTNER THERAPY AN INDIVIDUAL & FAMILY COUNSELING CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 04/12/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5360 JACKSON DR STE 218C
LA MESA CA
91942-6004
US

IV. Provider business mailing address

5360 JACKSON DR STE 218C
LA MESA CA
91942-6004
US

V. Phone/Fax

Practice location:
  • Phone: 858-342-2646
  • Fax: 619-467-7660
Mailing address:
  • Phone: 858-342-2646
  • Fax: 619-467-7660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KATE KUTNER
Title or Position: OWNER
Credential: LMFT
Phone: 858-342-2646