Provider Demographics
NPI:1538678925
Name:STODDARD, KATRINA MONIQUE (LMFT, LCMFT)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:MONIQUE
Last Name:STODDARD
Suffix:
Gender:F
Credentials:LMFT, LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4220 CAMPBELL ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64110-1136
Mailing Address - Country:US
Mailing Address - Phone:816-533-2371
Mailing Address - Fax:
Practice Address - Street 1:601 E 63RD ST STE 340
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64110-3303
Practice Address - Country:US
Practice Address - Phone:816-287-0121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-28
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013039841106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist