Healthcare Provider Details

I. General information

NPI: 1386811016
Provider Name (Legal Business Name): GARY SCOTT KATZ PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 05/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 MARIN ST SUITE 124C
THOUSAND OAKS CA
91360-4261
US

IV. Provider business mailing address

509 MARIN ST SUITE 124C
THOUSAND OAKS CA
91360-4261
US

V. Phone/Fax

Practice location:
  • Phone: 805-373-8365
  • Fax: 805-373-8367
Mailing address:
  • Phone: 805-373-8365
  • Fax: 805-373-8367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 17371
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: