Provider Demographics
NPI:1114679131
Name:STODDARD, KATHRYN ALISON (LMFT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ALISON
Last Name:STODDARD
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:STODDARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:PO BOX 19268
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619-0268
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6567 LUCAS AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-2940
Practice Address - Country:US
Practice Address - Phone:415-226-9236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-20
Last Update Date:2022-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110918106H00000X
CA134698106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist