Healthcare Provider Details

I. General information

NPI: 1912855859
Provider Name (Legal Business Name): KATHERINE MACLEOD
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4880 MARKET ST
VENTURA CA
93003-7783
US

IV. Provider business mailing address

4562 MARLOMA DR
ROLLING HILLS ESTATES CA
90274-1535
US

V. Phone/Fax

Practice location:
  • Phone: 866-600-7598
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number161141
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: