Provider Demographics
NPI:1174554109
Name:PAWLISCH, KATHIE B (MFT)
Entity type:Individual
Prefix:MRS
First Name:KATHIE
Middle Name:B
Last Name:PAWLISCH
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:674 VIA DE LA VALLE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-3407
Mailing Address - Country:US
Mailing Address - Phone:858-792-7274
Mailing Address - Fax:760-944-8131
Practice Address - Street 1:674 VIA DE LA VALLE
Practice Address - Street 2:SUITE 204
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-3407
Practice Address - Country:US
Practice Address - Phone:858-792-7274
Practice Address - Fax:760-944-8131
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT15545106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist