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General NPI Number Information
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NPI Number | 1063889004
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Entity Type | Individual
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Provider Name | KATHERINE KISMET OCHOA JAGIELLO M.A., M.S., LMFT
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Gender | Female
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Dates
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Enumeration Date | 08/25/2015
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 658 E BRIER DR
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-2880
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Country | US
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Telephone | 800-968-2636
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Fax | 909-252-5768
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Provider Business Mailing Address
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Address Line | PO BOX 1066
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City | YUCAIPA
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State | CA
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Zip | 92399-1066
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Country | US
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Telephone | 800-968-2636
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Fax | 909-501-0832
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | IMF 83162
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 104575
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License Number State | CA
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