Provider Demographics
NPI:1316125586
Name:BARTENHAGEN, KATY MARIE (MA, LMFT)
Entity type:Individual
Prefix:MS
First Name:KATY
Middle Name:MARIE
Last Name:BARTENHAGEN
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:KATY
Other - Middle Name:MARIE
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:1049 COLEMAN RD APT 4301
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-6720
Mailing Address - Country:US
Mailing Address - Phone:408-823-1882
Mailing Address - Fax:
Practice Address - Street 1:1101 S WINCHESTER BLVD
Practice Address - Street 2:STE. N265
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-3901
Practice Address - Country:US
Practice Address - Phone:408-823-1882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-09
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52778106H00000X
172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No172V00000XOther Service ProvidersCommunity Health Worker