Provider Demographics
NPI:1073645321
Name:STUART, KATHLEEN M (MFTI)
Entity type:Individual
Prefix:MISS
First Name:KATHLEEN
Middle Name:M
Last Name:STUART
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 S OAK KNOLL AVE
Mailing Address - Street 2:APT. #14
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2926
Mailing Address - Country:US
Mailing Address - Phone:323-543-4231
Mailing Address - Fax:
Practice Address - Street 1:7003 N FIGUEROA ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90042-1247
Practice Address - Country:US
Practice Address - Phone:323-543-4231
Practice Address - Fax:323-344-7382
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46508106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist