Provider Demographics
NPI:1609354687
Name:MADDOX, CATHERINE O (LMFT)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:O
Last Name:MADDOX
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 1:1855 BROOKTREE CT
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-1202
Mailing Address - Country:US
Mailing Address - Phone:818-317-4423
Mailing Address - Fax:
Practice Address - Street 1:30423 CANWOOD ST STE 129
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-4315
Practice Address - Country:US
Practice Address - Phone:805-380-4637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA93548106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist