Healthcare Provider Details

I. General information

NPI: 1396178778
Provider Name (Legal Business Name): KATHERINE NICE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE STORER

II. Dates (important events)

Enumeration Date: 08/20/2013
Last Update Date: 05/15/2020
Certification Date: 05/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 MOORPARK AVE STE 300
SAN JOSE CA
95128-2680
US

IV. Provider business mailing address

2400 MOORPARK AVE STE 300
SAN JOSE CA
95128-2680
US

V. Phone/Fax

Practice location:
  • Phone: 408-975-2730
  • Fax: 408-998-1535
Mailing address:
  • Phone: 408-287-6200
  • Fax: 408-998-1535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF #73921
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: