Provider Demographics
NPI:1063889004
Name:JAGIELLO, KATHERINE KISMET OCHOA (MA, MS, LMFT)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:KISMET OCHOA
Last Name:JAGIELLO
Suffix:
Gender:F
Credentials:MA, MS, LMFT
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:KISMET
Other - Last Name:OCHOA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, MS, LMFT
Mailing Address - Street 1:PO BOX 1066
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-1066
Mailing Address - Country:US
Mailing Address - Phone:800-968-2636
Mailing Address - Fax:909-501-0832
Practice Address - Street 1:658 E BRIER DR
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-2880
Practice Address - Country:US
Practice Address - Phone:800-968-2636
Practice Address - Fax:909-252-5768
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-25
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 83162106H00000X
CA104575106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist