Provider Demographics
NPI:1760719629
Name:WHITE, KATHRYN J (MFT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:J
Last Name:WHITE
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 1:1685 WESTWOOD DR
Mailing Address - Street 2:SUITE #11
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-5104
Mailing Address - Country:US
Mailing Address - Phone:408-979-1030
Mailing Address - Fax:
Practice Address - Street 1:1685 WESTWOOD DR
Practice Address - Street 2:SUITE #11
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-5104
Practice Address - Country:US
Practice Address - Phone:408-979-1030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 33943106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist