Provider Demographics
NPI:1427889161
Name:O'BLENNIS YVANOVICH, KATHERINE (AMFT)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:O'BLENNIS YVANOVICH
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1537 DRY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-4619
Mailing Address - Country:US
Mailing Address - Phone:408-421-8352
Mailing Address - Fax:
Practice Address - Street 1:4010 MOORPARK AVE STE 118
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95117-1803
Practice Address - Country:US
Practice Address - Phone:650-297-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA142635106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist