Healthcare Provider Details

I. General information

NPI: 1134636137
Provider Name (Legal Business Name): KAITLIN GALANTE HARUNK M.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATIE HARUNK M.S

II. Dates (important events)

Enumeration Date: 12/29/2017
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5188 BALBOA ARMS DR APT B4
SAN DIEGO CA
92117-4919
US

IV. Provider business mailing address

5188 BALBOA ARMS DR APT B4
SAN DIEGO CA
92117-4919
US

V. Phone/Fax

Practice location:
  • Phone: 310-508-6857
  • Fax:
Mailing address:
  • Phone: 310-508-6857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14830
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC23983
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: