Provider Demographics
NPI:1487950820
Name:ANTOLIN, KATHRYN DEVIS (LMFT)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:DEVIS
Last Name:ANTOLIN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7318 W POST RD STE 211
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-6646
Mailing Address - Country:US
Mailing Address - Phone:850-889-0929
Mailing Address - Fax:
Practice Address - Street 1:7318 W POST RD STE 211
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-6646
Practice Address - Country:US
Practice Address - Phone:850-889-0929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA98266106H00000X
NV01471106H00000X
NV20000403-810101Y00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health