Provider Demographics
NPI:1386811016
Name:KATZ, GARY SCOTT (PHD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:SCOTT
Last Name:KATZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 MARIN ST
Mailing Address - Street 2:SUITE 124C
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-4261
Mailing Address - Country:US
Mailing Address - Phone:805-373-8365
Mailing Address - Fax:805-373-8367
Practice Address - Street 1:509 MARIN ST
Practice Address - Street 2:SUITE 124C
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-4261
Practice Address - Country:US
Practice Address - Phone:805-373-8365
Practice Address - Fax:805-373-8367
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 17371103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical