Provider Demographics
NPI:1205505476
Name:ETTINGER, KATE C (MFT TRAINEE)
Entity type:Individual
Prefix:
First Name:KATE
Middle Name:C
Last Name:ETTINGER
Suffix:
Gender:F
Credentials:MFT TRAINEE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19622 HAYNES ST
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-5730
Mailing Address - Country:US
Mailing Address - Phone:646-236-5220
Mailing Address - Fax:
Practice Address - Street 1:11500 W OLYMPIC BLVD STE 400
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1525
Practice Address - Country:US
Practice Address - Phone:303-335-0996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-09
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CAAMFT137050106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist