Provider Demographics
NPI:1861502866
Name:BROSSARD-BIRD, KATHY (MFT)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:
Last Name:BROSSARD-BIRD
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 1:6393 SKYWAY
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-4543
Mailing Address - Country:US
Mailing Address - Phone:530-877-9491
Mailing Address - Fax:530-877-9491
Practice Address - Street 1:6393 SKYWAY
Practice Address - Street 2:SUITE 6
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-4543
Practice Address - Country:US
Practice Address - Phone:530-877-9491
Practice Address - Fax:530-877-9491
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC25359106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist