Provider Demographics
NPI:1023540820
Name:KNUDSEN, KATHRYN (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:
Last Name:KNUDSEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 ALPINE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95030-7130
Mailing Address - Country:US
Mailing Address - Phone:408-930-2397
Mailing Address - Fax:
Practice Address - Street 1:25 ALPINE AVE
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030-7130
Practice Address - Country:US
Practice Address - Phone:408-930-2397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT98527106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist