Provider Demographics
NPI:1598028235
Name:COTHRAN, KATHARINE RYAN
Entity type:Individual
Prefix:
First Name:KATHARINE
Middle Name:RYAN
Last Name:COTHRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 N ASH ST
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92027-1902
Mailing Address - Country:US
Mailing Address - Phone:760-741-7708
Mailing Address - Fax:760-741-5421
Practice Address - Street 1:620 N ASH ST
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92027-1902
Practice Address - Country:US
Practice Address - Phone:760-741-7708
Practice Address - Fax:760-741-5421
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)