Healthcare Provider Details

I. General information

NPI: 1710562632
Provider Name (Legal Business Name): KAITLYN BATHEL M.ED, LEP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2021
Last Update Date: 03/11/2021
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2336 CHAPALA ST
SANTA BARBARA CA
93105-3909
US

IV. Provider business mailing address

2336 CHAPALA ST
SANTA BARBARA CA
93105-3909
US

V. Phone/Fax

Practice location:
  • Phone: 805-403-3445
  • Fax:
Mailing address:
  • Phone: 805-403-3445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number4072
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: