Provider Demographics
NPI:1770919953
Name:NESBITT, KATHLEEN KAY (MA, MFT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:KAY
Last Name:NESBITT
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:NESBITT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, MFT
Mailing Address - Street 1:1137 2ND ST STE 209
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5081
Mailing Address - Country:US
Mailing Address - Phone:310-395-5454
Mailing Address - Fax:
Practice Address - Street 1:1137 2ND ST STE 209
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5081
Practice Address - Country:US
Practice Address - Phone:310-395-5454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC38539106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist