Healthcare Provider Details

I. General information

NPI: 1841692431
Provider Name (Legal Business Name): KATIE LYN MCBAIN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2014
Last Update Date: 03/14/2020
Certification Date: 03/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 N B ST
LOMPOC CA
93436-6901
US

IV. Provider business mailing address

500 W FOSTER RD
SANTA MARIA CA
93455-3620
US

V. Phone/Fax

Practice location:
  • Phone: 805-335-0376
  • Fax:
Mailing address:
  • Phone: 805-934-6385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number91871
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number109154
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: