Provider Demographics
NPI:1699848655
Name:GOODBOY, KATHLEEN ANN (MS, MFT)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:ANN
Last Name:GOODBOY
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:MRS
Other - First Name:KATHLEEN
Other - Middle Name:ANN
Other - Last Name:STANFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:2601 EAST CHAPMAN AVE.
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831
Mailing Address - Country:US
Mailing Address - Phone:714-337-1119
Mailing Address - Fax:714-773-0858
Practice Address - Street 1:2601 EAST CHAPMAN AVE.
Practice Address - Street 2:SUITE 105
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831
Practice Address - Country:US
Practice Address - Phone:714-337-1119
Practice Address - Fax:714-773-0858
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT34768106H00000X
CALMFT34768106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist