Provider Demographics
NPI:1295978062
Name:BLACKWELL, KATHERINE MARIE MACLAY (LMFT)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE MARIE
Middle Name:MACLAY
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:KATHERINE MARIE
Other - Middle Name:MACLAY
Other - Last Name:TEAGUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:33920 SUMMIT VIEW PL
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-5649
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:31045 TEMECULA PKWY STE 204
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-3085
Practice Address - Country:US
Practice Address - Phone:951-234-4871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-09
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86419106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist