Provider Demographics
NPI:1477572766
Name:LEWCZYK, KATHY MACKIE (MFT)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:MACKIE
Last Name:LEWCZYK
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 N POMONA AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-1927
Mailing Address - Country:US
Mailing Address - Phone:714-525-4014
Mailing Address - Fax:
Practice Address - Street 1:321 N POMONA AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-1927
Practice Address - Country:US
Practice Address - Phone:714-525-4014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36454101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health