Provider Demographics
NPI:1992489868
Name:WEBSTER, KATELYN DANIELLE (MA)
Entity type:Individual
Prefix:MRS
First Name:KATELYN
Middle Name:DANIELLE
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:KATELYN
Other - Middle Name:DANIELLE
Other - Last Name:WALSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3350 LA JOLLA VILLAGE DR.
Mailing Address - Street 2:BU664; CO: KATELYN WEBSTER
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92161
Mailing Address - Country:US
Mailing Address - Phone:858-552-8585
Mailing Address - Fax:
Practice Address - Street 1:3350 LA JOLLA VILLAGE DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92161-0002
Practice Address - Country:US
Practice Address - Phone:858-552-8585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA118372106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist