Provider Demographics
NPI:1225333214
Name:VAN DUSEN, KIM CATHERINE (PSYD, LMFT, RPT)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:CATHERINE
Last Name:VAN DUSEN
Suffix:
Gender:F
Credentials:PSYD, LMFT, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30777 RANCHO CALIFORNIA RD UNIT 891412
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92589-6058
Mailing Address - Country:US
Mailing Address - Phone:760-278-1425
Mailing Address - Fax:760-692-6470
Practice Address - Street 1:9466 BLACK MOUNTAIN RD STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4550
Practice Address - Country:US
Practice Address - Phone:858-689-2027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-21
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61664103K00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst