Provider Demographics
NPI:1689914442
Name:MADSEN, KATIE (MFT, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:
Last Name:MADSEN
Suffix:
Gender:F
Credentials:MFT, BCBA
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:ESCHWEGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15720 VENTURA BLVD
Mailing Address - Street 2:403
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2914
Mailing Address - Country:US
Mailing Address - Phone:818-788-2388
Mailing Address - Fax:818-788-3875
Practice Address - Street 1:15720 VENTURA BLVD
Practice Address - Street 2:403
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2914
Practice Address - Country:US
Practice Address - Phone:818-788-2388
Practice Address - Fax:818-788-3875
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-15
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-12-12476103K00000X
CAMFC47094106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst