1770919953 NPI number — KATHLEEN KAY NESBITT M.A., MFT

Table of content: KATHLEEN KAY NESBITT M.A., MFT (NPI 1770919953)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770919953 NPI number — KATHLEEN KAY NESBITT M.A., MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NESBITT
Provider First Name:
KATHLEEN
Provider Middle Name:
KAY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A., MFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NESBITT
Provider Other First Name:
KATE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A., MFT
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1770919953
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1137 2ND ST STE 209
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA MONICA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90403-5081
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-395-5454
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1137 2ND ST STE 209
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA MONICA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90403-5081
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-395-5454
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/19/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFC38539 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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