Provider Demographics
NPI:1629859434
Name:WORDEN, KATIE
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:WORDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1527 E WALNUT AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-7065
Mailing Address - Country:US
Mailing Address - Phone:714-457-8154
Mailing Address - Fax:
Practice Address - Street 1:377 E CHAPMAN AVE STE 105
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-5085
Practice Address - Country:US
Practice Address - Phone:714-457-8154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA131007106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist