Healthcare Provider Details

I. General information

NPI: 1700635315
Provider Name (Legal Business Name): KATHRYN MARY SANDVIG LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHRYN MARY CONNOLLY

II. Dates (important events)

Enumeration Date: 05/15/2024
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 E HILLCREST DR STE 115
THOUSAND OAKS CA
91360-7782
US

IV. Provider business mailing address

516 RUNNING CREEK CT
SIMI VALLEY CA
93065-5453
US

V. Phone/Fax

Practice location:
  • Phone: 805-601-5200
  • Fax:
Mailing address:
  • Phone: 805-501-6157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number160456
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: