Provider Demographics
NPI:1043506249
Name:JAMES, KATHERINE ELLEN
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:ELLEN
Last Name:JAMES
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 1:21250 BOX SPRINGS RD STE 106
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-8707
Mailing Address - Country:US
Mailing Address - Phone:951-369-8036
Mailing Address - Fax:
Practice Address - Street 1:21250 BOX SPRINGS RD STE 106
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-8707
Practice Address - Country:US
Practice Address - Phone:951-369-8036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-26
Last Update Date:2011-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62714106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist