Provider Demographics
NPI:1629196274
Name:MERRITT, KATHRYN SUSAN (MFT INTERN)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:SUSAN
Last Name:MERRITT
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 SCOTT ST APT 10
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-2341
Mailing Address - Country:US
Mailing Address - Phone:619-316-5794
Mailing Address - Fax:
Practice Address - Street 1:7841 EL CAJON BLVD
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-3709
Practice Address - Country:US
Practice Address - Phone:619-697-2388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50720106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist