Provider Demographics
NPI:1932929130
Name:FREES, KATHERINE NICOLE
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:NICOLE
Last Name:FREES
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 1:2867 INSTONE CT
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-3710
Mailing Address - Country:US
Mailing Address - Phone:805-341-2828
Mailing Address - Fax:
Practice Address - Street 1:16530 VENTURA BLVD STE 400
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4551
Practice Address - Country:US
Practice Address - Phone:805-910-7748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-12
Last Update Date:2024-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA150552106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist