Provider Demographics
NPI:1710562632
Name:BATHEL, KAITLYN (MED, LEP)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:BATHEL
Suffix:
Gender:F
Credentials:MED, LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2336 CHAPALA ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-3909
Mailing Address - Country:US
Mailing Address - Phone:805-403-3445
Mailing Address - Fax:
Practice Address - Street 1:2336 CHAPALA ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-3909
Practice Address - Country:US
Practice Address - Phone:805-403-3445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4072103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool