Provider Demographics
NPI:1184848426
Name:PFEIFFER POLEN, KATIE LYNNE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KATIE
Middle Name:LYNNE
Last Name:PFEIFFER POLEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:KATIE
Other - Middle Name:LYNNE
Other - Last Name:PFEIFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:683 VALLEY VISTA DR
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-1639
Mailing Address - Country:US
Mailing Address - Phone:805-795-3221
Mailing Address - Fax:
Practice Address - Street 1:683 VALLEY VISTA DR
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-1639
Practice Address - Country:US
Practice Address - Phone:805-795-3221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2024-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YM0800X, 171M00000X
CARPS2011007103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist