Provider Demographics
NPI:1174041750
Name:WATKINS, KATRINA LORIEL (AMFT)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:LORIEL
Last Name:WATKINS
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:MS
Other - First Name:KATRINA
Other - Middle Name:LORIEL
Other - Last Name:WATKINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:1429 N STUDEBAKER RD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-4838
Mailing Address - Country:US
Mailing Address - Phone:213-842-3754
Mailing Address - Fax:
Practice Address - Street 1:1429 N STUDEBAKER RD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-4838
Practice Address - Country:US
Practice Address - Phone:213-842-3754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-05
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA139174106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist