Provider Demographics
NPI:1558458869
Name:STOLL, KATHRYN LATHAM (LMFT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:LATHAM
Last Name:STOLL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 COMMERCE ST STE B
Mailing Address - Street 2:
Mailing Address - City:MCCALL
Mailing Address - State:ID
Mailing Address - Zip Code:83638-5192
Mailing Address - Country:US
Mailing Address - Phone:949-395-2063
Mailing Address - Fax:
Practice Address - Street 1:125 COMMERCE ST STE B
Practice Address - Street 2:
Practice Address - City:MCCALL
Practice Address - State:ID
Practice Address - Zip Code:83638-5192
Practice Address - Country:US
Practice Address - Phone:208-634-2962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 40587106H00000X
IDLMFT-6984106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist