Provider Demographics
NPI:1134636137
Name:HARUNK, KAITLIN (MS)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:HARUNK
Suffix:
Gender:
Credentials:MS
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:HARUNK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:5188 BALBOA ARMS DR APT B4
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-4919
Mailing Address - Country:US
Mailing Address - Phone:310-508-6857
Mailing Address - Fax:
Practice Address - Street 1:5250 CAMPANILE DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92182-1893
Practice Address - Country:US
Practice Address - Phone:619-530-0122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
CA14830101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician