Provider Demographics
NPI:1639362049
Name:PARK, KAITLIN ROSE MURRAY (MA LMFT)
Entity type:Individual
Prefix:MRS
First Name:KAITLIN
Middle Name:ROSE MURRAY
Last Name:PARK
Suffix:
Gender:F
Credentials:MA LMFT
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:ROSE
Other - Last Name:MURRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2121 5TH AVENUE #110
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2139
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2121 5TH AVE STE 110
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-2139
Practice Address - Country:US
Practice Address - Phone:858-774-0127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84803106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist