Healthcare Provider Details

I. General information

NPI: 1245954205
Provider Name (Legal Business Name): KATIE ANN CHAMPIEUX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

671 IMPERIAL DR
PACIFICA CA
94044-1754
US

IV. Provider business mailing address

671 IMPERIAL DR
PACIFICA CA
94044-1754
US

V. Phone/Fax

Practice location:
  • Phone: 415-948-1737
  • Fax:
Mailing address:
  • Phone: 415-948-1737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number133324
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: