Provider Demographics
NPI:1962831297
Name:MCSPADDEN, KATHLEEN LAUREN (LMFT)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:LAUREN
Last Name:MCSPADDEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:LAUREN
Other - Last Name:PFEIFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:1303 SAN CARLOS AVE.
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070
Mailing Address - Country:US
Mailing Address - Phone:415-680-3340
Mailing Address - Fax:
Practice Address - Street 1:1303 SAN CARLOS AVE.
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070
Practice Address - Country:US
Practice Address - Phone:415-680-3340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA71735106H00000X
CA88894106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty