Provider Demographics
NPI:1265534796
Name:REID, KATHLEEN A (MS, MFT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:REID
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:KAREY
Other - Middle Name:
Other - Last Name:REID
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, MFT
Mailing Address - Street 1:550 G AVE
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-1620
Mailing Address - Country:US
Mailing Address - Phone:619-435-4388
Mailing Address - Fax:619-435-2993
Practice Address - Street 1:138 B AVE
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-1511
Practice Address - Country:US
Practice Address - Phone:619-435-4388
Practice Address - Fax:619-435-2993
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC23142106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist