Healthcare Provider Details

I. General information

NPI: 1164016838
Provider Name (Legal Business Name): KATHLEEN DEE DALE LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2021
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3609 OCEAN RANCH BLVD STE 208&209
OCEANSIDE CA
92056-2698
US

IV. Provider business mailing address

3609 OCEAN RANCH BLVD STE 208&209
OCEANSIDE CA
92056-2698
US

V. Phone/Fax

Practice location:
  • Phone: 858-279-1223
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number148149
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number120893
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: