Provider Demographics
NPI:1487004602
Name:WILLIAMS, KATLYN (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:KATLYN
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:KATLYN
Other - Middle Name:
Other - Last Name:WALTNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27762 ANTONIO PKWY # L1-634
Mailing Address - Street 2:
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-1140
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:23121 VERDUGO DR STE 200
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1339
Practice Address - Country:US
Practice Address - Phone:949-529-2917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101056106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist