Provider Demographics
NPI:1134487143
Name:MECHEM, KATHARINE WHITNEY (LMFT)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:WHITNEY
Last Name:MECHEM
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 21325
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94620-1325
Mailing Address - Country:US
Mailing Address - Phone:510-318-4454
Mailing Address - Fax:
Practice Address - Street 1:2931 SHATTUCK AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1808
Practice Address - Country:US
Practice Address - Phone:510-318-4454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC45411106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist