Provider Demographics
NPI:1639366446
Name:ROSS, KATHRYN ELAINE (MA)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:ELAINE
Last Name:ROSS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MISS
Other - First Name:KATHRYN
Other - Middle Name:ELAINE
Other - Last Name:MEHRINGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:PO BOX 950
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-0950
Mailing Address - Country:US
Mailing Address - Phone:530-529-9454
Mailing Address - Fax:530-529-9456
Practice Address - Street 1:590 ANTELOPE BLVD STE 40A
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-2477
Practice Address - Country:US
Practice Address - Phone:530-529-9454
Practice Address - Fax:530-529-9456
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 52946106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1639366446OtherNPI