Provider Demographics
NPI:1629135280
Name:RIVKIND, AGATHA (KATIE) THERESA (LMFT)
Entity type:Individual
Prefix:MS
First Name:AGATHA (KATIE)
Middle Name:THERESA
Last Name:RIVKIND
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:PO BOX 433
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92885-0433
Mailing Address - Country:US
Mailing Address - Phone:714-324-2929
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 433
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92885-0433
Practice Address - Country:US
Practice Address - Phone:714-324-2929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43632106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist