MEDICARE: DR. KATHERYN LEANNE WHITTAKER PSYD, LMFT, LPCC

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
1	106H00000X	Marriage & Family Therapist	43908	CA
2	101YP2500X	Professional Counselor	3	CA

General Provider Information

NPI Number	:	1639299407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHERYN LEANNE WHITTAKER PSYD, LMFT, LPCC

Provider Business Mailing Address
First Line	:	909 PICO BLVD
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-1326
Country	:	US
Telephone Number	:	714-931-9331
Fax Number	:

Provider Business Practice Location Address
First Line	:	909 PICO BLVD
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-1326
Country	:	US
Telephone Number	:	714-931-9331
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	12/27/2016

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