Provider Demographics
NPI:1588780829
Name:BRECKENRIDGE, KATI (PHD)
Entity type:Individual
Prefix:DR
First Name:KATI
Middle Name:
Last Name:BRECKENRIDGE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9850 EASTON DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-1418
Mailing Address - Country:US
Mailing Address - Phone:310-446-0064
Mailing Address - Fax:
Practice Address - Street 1:1800 FAIRBURN AVE STE 205
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-4968
Practice Address - Country:US
Practice Address - Phone:310-446-0064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY. 4059103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist