Provider Demographics
NPI:1497764146
Name:CHAMBLISS, CATHERINE LINNEA (MFT)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:LINNEA
Last Name:CHAMBLISS
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 1:2615 PACIFIC COAST HWY
Mailing Address - Street 2:#325
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-2225
Mailing Address - Country:US
Mailing Address - Phone:310-303-9132
Mailing Address - Fax:310-379-6838
Practice Address - Street 1:2615 PACIFIC COAST HWY
Practice Address - Street 2:#325
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-2225
Practice Address - Country:US
Practice Address - Phone:310-303-9132
Practice Address - Fax:310-379-6838
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC39875106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist