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General NPI Number Information
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NPI Number | 1043835408
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Entity Type | Organization
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Legal Business Name | LIFE TREE PSYCHOLOGICAL SERVICES, P.C.
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Dates
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Enumeration Date | 06/11/2020
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Last Update Date | 06/11/2020
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Provider Practice Location Address
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Address Line | 150 W. SIERRA MADRE BLVD.
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City | SIERRA MADRE
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State | CA
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Zip | 91024
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Country | US
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Telephone | 626-808-7534
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Fax | 626-921-0005
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Provider Business Mailing Address
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Address Line | 150 W. SIERRA MADRE BLVD
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City | SIERRA MADRE
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State | CA
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Zip | 91024
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Country | US
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Telephone | 626-808-7534
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KATHARINE M PUTMAN
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Credential | PSY.D.
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Telephone | 626-808-7534
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TF0000X
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Taxonomy Name | Family Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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