Healthcare Provider Details

I. General information

NPI: 1457269508
Provider Name (Legal Business Name): KATHARINE COSTELLO LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 W MAIN ST STE 103
TUSTIN CA
92780-7712
US

IV. Provider business mailing address

3943 IRVINE BLVD # 426
IRVINE CA
92602-2400
US

V. Phone/Fax

Practice location:
  • Phone: 714-584-9345
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number165040
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: