Provider Demographics
NPI:1265650816
Name:GATES, KATHLEEN BUDKE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:BUDKE
Last Name:GATES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:KATHLEEN
Other - Middle Name:LOVINA
Other - Last Name:BUDKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:644 E THOMPSON BLVD
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-2829
Mailing Address - Country:US
Mailing Address - Phone:805-648-2548
Mailing Address - Fax:805-652-0745
Practice Address - Street 1:644 E THOMPSON BLVD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-2829
Practice Address - Country:US
Practice Address - Phone:805-648-2548
Practice Address - Fax:805-652-0745
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 7386103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY7386OtherCA STATE PSYCHOLOGIST LIC