Provider Demographics
NPI:1780022418
Name:WEST, KATIE LYNN (MFT)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:LYNN
Last Name:WEST
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 1:505 S VILLA REAL STE 117
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-3441
Mailing Address - Country:US
Mailing Address - Phone:949-412-3256
Mailing Address - Fax:
Practice Address - Street 1:505 S VILLA REAL STE 117
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-3441
Practice Address - Country:US
Practice Address - Phone:949-412-3256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 53283101YM0800X
CAMFC53283101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health