Provider Demographics
NPI:1043835408
Name:LIFE TREE PSYCHOLOGICAL SERVICES, P.C.
Entity Type:Organization
Organization Name:LIFE TREE PSYCHOLOGICAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHARINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:PUTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:626-808-7534
Mailing Address - Street 1:150 W. SIERRA MADRE BLVD
Mailing Address - Street 2:
Mailing Address - City:SIERRA MADRE
Mailing Address - State:CA
Mailing Address - Zip Code:91024
Mailing Address - Country:US
Mailing Address - Phone:626-808-7534
Mailing Address - Fax:
Practice Address - Street 1:150 W. SIERRA MADRE BLVD.
Practice Address - Street 2:
Practice Address - City:SIERRA MADRE
Practice Address - State:CA
Practice Address - Zip Code:91024
Practice Address - Country:US
Practice Address - Phone:626-808-7534
Practice Address - Fax:626-921-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Multi-Specialty