Healthcare Provider Details

I. General information

NPI: 1902056492
Provider Name (Legal Business Name): KATHLEEN ELIZABETH SLIJEPCEVIC PSY.D, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2008
Last Update Date: 09/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S. DELACEY AVE. SUITE 110
PASADENA CA
91105
US

IV. Provider business mailing address

210 S. DELACEY AVE. SUITE 110
PASADENA CA
91105
US

V. Phone/Fax

Practice location:
  • Phone: 626-395-7100
  • Fax:
Mailing address:
  • Phone: 626-395-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 45860
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: