Healthcare Provider Details

I. General information

NPI: 1083536908
Provider Name (Legal Business Name): KATHERINE NICOLE WEBB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE NICOLE BACKUS

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 S BUNDY DR STE 385
LOS ANGELES CA
90025-5245
US

IV. Provider business mailing address

1990 S BUNDY DR STE 385
LOS ANGELES CA
90025-5245
US

V. Phone/Fax

Practice location:
  • Phone: 409-466-9492
  • Fax:
Mailing address:
  • Phone: 409-466-9492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number159415
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: