Provider Demographics
NPI:1851328918
Name:KAUTNER, VARIDA (PHD, LMFT)
Entity type:Individual
Prefix:DR
First Name:VARIDA
Middle Name:
Last Name:KAUTNER
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2916 NW BUCKLIN HILL RD
Mailing Address - Street 2:APT. 262
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8514
Mailing Address - Country:US
Mailing Address - Phone:415-361-8038
Mailing Address - Fax:510-373-2342
Practice Address - Street 1:7462 NW IOKA DR
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-9332
Practice Address - Country:US
Practice Address - Phone:415-361-8038
Practice Address - Fax:510-373-2342
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC31124106H00000X
WAMFT.LF.60591254106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
11334010OtherCAQH NUMBER
7625515OtherAETNA PROVIDER NUMBER
VA116724OtherBC/BS PROVIDER NUMBER