Provider Demographics
NPI:1023444635
Name:TINSLEY, KATHRYN (LEP)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:
Last Name:TINSLEY
Suffix:
Gender:F
Credentials:LEP
Other - Prefix:MS
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:NICHOLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 90113
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90809-0113
Mailing Address - Country:US
Mailing Address - Phone:562-606-6624
Mailing Address - Fax:
Practice Address - Street 1:7755 CENTER AVE
Practice Address - Street 2:SUITE 1100
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3007
Practice Address - Country:US
Practice Address - Phone:714-270-9004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3389103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool