Healthcare Provider Details

I. General information

NPI: 1942546346
Provider Name (Legal Business Name): KITEHILL PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2012
Last Update Date: 12/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 CAMINO ALTO SUITE E1
MILL VALLEY CA
94941-2254
US

IV. Provider business mailing address

131 CAMINO ALTO SUITE E1
MILL VALLEY CA
94941-2254
US

V. Phone/Fax

Practice location:
  • Phone: 415-381-9600
  • Fax: 415-381-9611
Mailing address:
  • Phone: 415-381-9600
  • Fax: 415-381-9611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY24593
License Number StateCA

VIII. Authorized Official

Name: BELINDA STROUD
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PSY.D.
Phone: 415-381-9600