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General NPI Number Information
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NPI Number | 1578073367
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Entity Type | Individual
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Provider Name | KATY LAUREN M HEADLEY
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Gender | Female
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Dates
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Enumeration Date | 10/05/2017
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Last Update Date | 05/09/2022
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Provider Practice Location Address
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Address Line | 1030 NEVADA ST STE 200
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City | REDLANDS
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State | CA
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Zip | 92374-2958
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Country | US
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Telephone | 909-347-9270
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Fax |
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Provider Business Mailing Address
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Address Line | 27261 LAS RAMBLAS STE 220
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City | MISSION VIEJO
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State | CA
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Zip | 92691-6468
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Country | US
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Telephone |
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6833
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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 | 115726
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 132536
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License Number State | CA
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