Provider Demographics
NPI:1548407158
Name:REAZER, KATHLEEN REGINA (MS, MFT)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:REGINA
Last Name:REAZER
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 SCIENCE DRIVE
Mailing Address - Street 2:#235
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-2094
Mailing Address - Country:US
Mailing Address - Phone:805-217-1224
Mailing Address - Fax:805-529-1004
Practice Address - Street 1:301 SCIENCE DR
Practice Address - Street 2:#235
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-2094
Practice Address - Country:US
Practice Address - Phone:805-217-1224
Practice Address - Fax:805-529-1004
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC43176106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist