Provider Demographics
NPI:1922138601
Name:PINE, KATHERINE GWYNNE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:GWYNNE
Last Name:PINE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:KATIE
Other - Middle Name:G
Other - Last Name:PINE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:12402 VENTURA BLVD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-2457
Mailing Address - Country:US
Mailing Address - Phone:310-420-7827
Mailing Address - Fax:
Practice Address - Street 1:12402 VENTURA BLVD
Practice Address - Street 2:2ND FLR
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2457
Practice Address - Country:US
Practice Address - Phone:310-420-7827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49909106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist