Provider Demographics
NPI:1063128973
Name:CONLON, KATHRYN B (AMFT)
Entity type:Individual
Prefix:MISS
First Name:KATHRYN
Middle Name:B
Last Name:CONLON
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:KATY
Other - Middle Name:
Other - Last Name:BIRD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AMFT
Mailing Address - Street 1:241 E 17TH ST # 1062
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-3831
Mailing Address - Country:US
Mailing Address - Phone:714-873-2803
Mailing Address - Fax:
Practice Address - Street 1:1635 E OCEAN BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-6001
Practice Address - Country:US
Practice Address - Phone:562-548-7639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA137091106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist