Provider Demographics
NPI:1689972903
Name:SMITH, KATHERINE
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 N SEPULVEDA BLVD
Mailing Address - Street 2:2075
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-4460
Mailing Address - Country:US
Mailing Address - Phone:310-414-2090
Mailing Address - Fax:310-414-2096
Practice Address - Street 1:360 N SEPULVEDA BLVD
Practice Address - Street 2:2075
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-4460
Practice Address - Country:US
Practice Address - Phone:310-414-2090
Practice Address - Fax:310-414-2096
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-10
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health