Provider Demographics
NPI:1104020189
Name:OSTENSEN, KAY WICKETT (PHD)
Entity Type:Individual
Prefix:MS
First Name:KAY
Middle Name:WICKETT
Last Name:OSTENSEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1278 GLENNEYRE
Mailing Address - Street 2:SUITE #22
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651
Mailing Address - Country:US
Mailing Address - Phone:949-494-5460
Mailing Address - Fax:949-209-8777
Practice Address - Street 1:1278 GLENNEYRE
Practice Address - Street 2:PSYCHOLOGY CENTER #D
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651
Practice Address - Country:US
Practice Address - Phone:949-494-5460
Practice Address - Fax:949-209-8777
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6951103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent