Healthcare Provider Details

I. General information

NPI: 1902983869
Provider Name (Legal Business Name): KATHLEEN ANNE TREIS M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 03/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6957 N FIGUEROA ST
LOS ANGELES CA
90042-1245
US

IV. Provider business mailing address

6957 N FIGUEROA ST PO BOX 41-1076
LOS ANGELES CA
90042-1245
US

V. Phone/Fax

Practice location:
  • Phone: 323-443-3134
  • Fax: 323-443-3265
Mailing address:
  • Phone: 323-443-3134
  • Fax: 323-443-3265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMF70102
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: