Provider Demographics
NPI:1609112481
Name:SCOTT, KATHRYN (MA, MFT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:SCOTT-LEWIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:71 W SIERRA MADRE BLVD
Mailing Address - Street 2:
Mailing Address - City:SIERRA MADRE
Mailing Address - State:CA
Mailing Address - Zip Code:91024-2462
Mailing Address - Country:US
Mailing Address - Phone:626-447-3288
Mailing Address - Fax:
Practice Address - Street 1:71 W SIERRA MADRE BLVD
Practice Address - Street 2:
Practice Address - City:SIERRA MADRE
Practice Address - State:CA
Practice Address - Zip Code:91024-2462
Practice Address - Country:US
Practice Address - Phone:626-447-3288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-23
Last Update Date:2012-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC29708101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health