Provider Demographics
NPI:1659726198
Name:HISEL, KATHRYN (LMFT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:HISEL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:ROM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:177 CARMINE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-0878
Mailing Address - Country:US
Mailing Address - Phone:949-445-1165
Mailing Address - Fax:
Practice Address - Street 1:600 W SANTA ANA BLVD
Practice Address - Street 2:STE 108
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-4558
Practice Address - Country:US
Practice Address - Phone:509-995-9411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-03
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CA115981106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)