Provider Demographics
NPI:1265607972
Name:DEPPE, KATHLEEN LARAINE (MFT-LICENSED)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:LARAINE
Last Name:DEPPE
Suffix:
Gender:F
Credentials:MFT-LICENSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5317 E THE TOLEDO APT 5
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-3573
Mailing Address - Country:US
Mailing Address - Phone:562-343-8879
Mailing Address - Fax:562-439-3800
Practice Address - Street 1:1945 PALO VERDE AVE STE 203
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-3445
Practice Address - Country:US
Practice Address - Phone:562-343-8879
Practice Address - Fax:562-439-3800
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC48345106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist