Provider Demographics
NPI:1215055900
Name:ABANATHIE, KATHRYN S (LMFT)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:S
Last Name:ABANATHIE
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 1:1604 FORD AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4649
Mailing Address - Country:US
Mailing Address - Phone:209-648-6003
Mailing Address - Fax:209-566-9561
Practice Address - Street 1:1604 FORD AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4649
Practice Address - Country:US
Practice Address - Phone:209-648-6003
Practice Address - Fax:209-566-9561
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46435106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist