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NPI Code Detail

MEDICARE: KATHRYN DE BRUIN FAMILY THERAPY AND TRAINING INC.

MEDICARE: KATHRYN DE BRUIN FAMILY THERAPY AND TRAINING INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist
2106H00000XMarriage & Family Therapist43615CA

General Provider Information

NPI Number : 1184043614
Entity Type Code : Organization
Provider Name (Legal Business Name) : KATHRYN DE BRUIN FAMILY THERAPY AND TRAINING INC.
Provider Business Mailing Address
First Line : 2851 CAMINO DEL RIO S STE 300
Second Line :
City : SAN DIEGO
State : CA
Zip : 92108-3814
Country : US
Telephone Number : 619-352-0064
Fax Number : 619-342-7753
Provider Business Practice Location Address
First Line : 2851 CAMINO DEL RIO S STE 300
Second Line :
City : SAN DIEGO
State : CA
Zip : 92108-3814
Country : US
Telephone Number : 619-352-0064
Fax Number : 619-342-7753
Authorized Official
Title or Position : PRESIDENT/OWNER
Name : MRS. KATHRYN N DE BRUIN
Credential : LMFT
Telephone Number : 619-840-3353
Provider Enumeration Date : 04/14/2014
Last Update Date : 12/08/2017

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