MEDICARE: KATE KUTNER THERAPY AN INDIVIDUAL & FAMILY COUNSELING CORP.

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1932789161
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KATE KUTNER THERAPY AN INDIVIDUAL & FAMILY COUNSELING CORP.

Provider Business Mailing Address
First Line	:	5360 JACKSON DR STE 218C
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91942-6004
Country	:	US
Telephone Number	:	858-342-2646
Fax Number	:	619-467-7660

Provider Business Practice Location Address
First Line	:	5360 JACKSON DR STE 218C
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91942-6004
Country	:	US
Telephone Number	:	858-342-2646
Fax Number	:	619-467-7660

Authorized Official
Title or Position	:	OWNER
Name	:	KATE KUTNER
Credential	:	LMFT
Telephone Number	:	858-342-2646

Provider Enumeration Date	:	04/12/2021
Last Update Date	:	04/12/2021

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