Provider Demographics
NPI:1245394774
Name:WISMER, KATHERINE M (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:M
Last Name:WISMER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 E YORBA LINDA BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-3760
Mailing Address - Country:US
Mailing Address - Phone:800-701-0937
Mailing Address - Fax:800-701-0937
Practice Address - Street 1:1041 E YORBA LINDA BLVD STE 202
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870
Practice Address - Country:US
Practice Address - Phone:800-701-0937
Practice Address - Fax:800-701-0937
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102441101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health