Provider Demographics
NPI:1235233974
Name:CROWE, KATHERINE JAMPOL (MFT)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:JAMPOL
Last Name:CROWE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MRS
Other - First Name:KATHERINE
Other - Middle Name:JAMPOL
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:701 SOUTHAMPTON ROAD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-2076
Mailing Address - Country:US
Mailing Address - Phone:707-745-9547
Mailing Address - Fax:707-745-9561
Practice Address - Street 1:701 SOUTHAMPTON ROAD
Practice Address - Street 2:SUITE 208
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-2076
Practice Address - Country:US
Practice Address - Phone:707-745-9547
Practice Address - Fax:707-745-9561
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC27756106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
67876OtherMANAGE HEALTH NETWORK
11001234OtherAETNA