Provider Demographics
NPI:1932126547
Name:STEAVENS, MARYKATE (PHD, MFT)
Entity Type:Individual
Prefix:
First Name:MARYKATE
Middle Name:
Last Name:STEAVENS
Suffix:
Gender:F
Credentials:PHD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1291 LA COLINA DR
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-2822
Mailing Address - Country:US
Mailing Address - Phone:714-330-6533
Mailing Address - Fax:
Practice Address - Street 1:19742 MACARTHUR BLVD
Practice Address - Street 2:,STE. 145
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-2432
Practice Address - Country:US
Practice Address - Phone:949-250-1248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 22096101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health