Healthcare Provider Details

I. General information

NPI: 1104435205
Provider Name (Legal Business Name): KATHERINE CHAN MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2020
Last Update Date: 01/22/2026
Certification Date: 01/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2052 S BUNDY DR # 1861
LOS ANGELES CA
90025-6102
US

IV. Provider business mailing address

2052 S BUNDY DR # 1861
LOS ANGELES CA
90025-6102
US

V. Phone/Fax

Practice location:
  • Phone: 310-997-0930
  • Fax:
Mailing address:
  • Phone: 310-997-0930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number134150
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number134150
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: