Provider Demographics
NPI:1720190069
Name:STULL WHITAKER, KATHRYN (MFT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:STULL WHITAKER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E REDLANDS BLVD
Mailing Address - Street 2:SUITE 234
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373
Mailing Address - Country:US
Mailing Address - Phone:909-335-3026
Mailing Address - Fax:909-335-3167
Practice Address - Street 1:707 MAGNOLIA AVE SUITE 1F
Practice Address - Street 2:INLAND PSYCHIATRIC MEDICAL GROUP INC
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879
Practice Address - Country:US
Practice Address - Phone:951-737-1917
Practice Address - Fax:951-735-4105
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC20744106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist