Provider Demographics
NPI:1740205681
Name:SHOTZ, KATHARINE D (MFT)
Entity Type:Individual
Prefix:MRS
First Name:KATHARINE
Middle Name:D
Last Name:SHOTZ
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 GRANT AVE
Mailing Address - Street 2:#328
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-3111
Mailing Address - Country:US
Mailing Address - Phone:415-203-2475
Mailing Address - Fax:415-209-1100
Practice Address - Street 1:1516 GRANT AVE
Practice Address - Street 2:#328
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-3111
Practice Address - Country:US
Practice Address - Phone:415-203-2475
Practice Address - Fax:415-209-1100
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35853101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health