Provider Demographics
NPI:1407198310
Name:KEGLEY, KATHRYN MEISTER (LMFT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MEISTER
Last Name:KEGLEY
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 1:659 VALLEY OAK LN
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91320-4036
Mailing Address - Country:US
Mailing Address - Phone:805-428-4393
Mailing Address - Fax:
Practice Address - Street 1:280 E THOUSAND OAKS BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-5824
Practice Address - Country:US
Practice Address - Phone:805-428-4393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC53096106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA46-2313892OtherEIN