Provider Demographics
NPI:1477691921
Name:MAHURIN, KATHLEEN JONES (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:JONES
Last Name:MAHURIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2535 FOREST AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-7691
Mailing Address - Country:US
Mailing Address - Phone:530-898-8608
Mailing Address - Fax:530-898-8608
Practice Address - Street 1:2535 FOREST AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-7691
Practice Address - Country:US
Practice Address - Phone:530-898-8608
Practice Address - Fax:530-898-8608
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 10363103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY 10363Medicare UPIN
CAOPL10363Medicare ID - Type Unspecified