Provider Demographics
NPI:1689009037
Name:MEADS, KATHLEEN JAYO (MFT INTERN)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:JAYO
Last Name:MEADS
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 1:5330 AVENIDA LA CANDELA
Mailing Address - Street 2:
Mailing Address - City:JOSHUA TREE
Mailing Address - State:CA
Mailing Address - Zip Code:92252-1869
Mailing Address - Country:US
Mailing Address - Phone:760-401-6504
Mailing Address - Fax:
Practice Address - Street 1:57407 29 PALMS HWY STE F
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-2907
Practice Address - Country:US
Practice Address - Phone:760-366-1541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist