Provider Demographics
NPI:1659689446
Name:HIGHLY, KATHLEEN ANNE (PHD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANNE
Last Name:HIGHLY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KAHTLEEN
Other - Middle Name:ANNE
Other - Last Name:HIGHLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:760 S. HILL STREET RD # 107
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003
Mailing Address - Country:US
Mailing Address - Phone:831-325-7008
Mailing Address - Fax:805-659-9959
Practice Address - Street 1:CLINICAS DEL CAMINO REAL, INCORPORATED
Practice Address - Street 2:200 S. WELLS RD., SUITE 200
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93004
Practice Address - Country:US
Practice Address - Phone:805-659-1740
Practice Address - Fax:805-659-9959
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16402103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist