Provider Demographics
NPI:1962500108
Name:RAMOS, KATHY M (MFT)
Entity type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:M
Last Name:RAMOS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 E CHAPMAN AVE UNIT 28
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-4252
Mailing Address - Country:US
Mailing Address - Phone:714-331-2930
Mailing Address - Fax:
Practice Address - Street 1:3333 S BREA CANYON RD
Practice Address - Street 2:SUITE 124
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-3786
Practice Address - Country:US
Practice Address - Phone:714-331-2030
Practice Address - Fax:714-961-2740
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT38150106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMF3815000OtherLA CO. PROVIDER NUMBER