Provider Demographics
NPI:1083822811
Name:WHITE, KATHARINE L (LMFT)
Entity Type:Individual
Prefix:MS
First Name:KATHARINE
Middle Name:L
Last Name:WHITE
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:PO BOX 2168
Mailing Address - Street 2:MENDOCINO COAST HOSPITALITY CENTER
Mailing Address - City:FORT BRAGG
Mailing Address - State:CA
Mailing Address - Zip Code:95437
Mailing Address - Country:US
Mailing Address - Phone:707-961-0172
Mailing Address - Fax:844-388-6167
Practice Address - Street 1:137 E OAK STREET
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437
Practice Address - Country:US
Practice Address - Phone:707-961-0172
Practice Address - Fax:844-388-6167
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC39991106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist