Provider Demographics
NPI:1992514582
Name:STEIN, KATHY LYNN
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:LYNN
Last Name:STEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KATHY
Other - Middle Name:LYNN
Other - Last Name:STEIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4712 INDIANOLA WAY
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-2640
Mailing Address - Country:US
Mailing Address - Phone:818-679-3832
Mailing Address - Fax:
Practice Address - Street 1:4712 INDIANOLA WAY
Practice Address - Street 2:
Practice Address - City:LA CANADA
Practice Address - State:CA
Practice Address - Zip Code:91011-2640
Practice Address - Country:US
Practice Address - Phone:818-679-3832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT28120106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist