Provider Demographics
NPI:1184043614
Name:KATHRYN DE BRUIN FAMILY THERAPY AND TRAINING INC.
Entity Type:Organization
Organization Name:KATHRYN DE BRUIN FAMILY THERAPY AND TRAINING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:N
Authorized Official - Last Name:DE BRUIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:619-840-3353
Mailing Address - Street 1:2851 CAMINO DEL RIO S STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3814
Mailing Address - Country:US
Mailing Address - Phone:619-352-0064
Mailing Address - Fax:619-342-7753
Practice Address - Street 1:2851 CAMINO DEL RIO S STE 300
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3814
Practice Address - Country:US
Practice Address - Phone:619-352-0064
Practice Address - Fax:619-342-7753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-14
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CA43615106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty