Provider Demographics
NPI:1780796011
Name:BRYDA, KATHARINE CAGLE (LMFT)
Entity type:Individual
Prefix:MRS
First Name:KATHARINE
Middle Name:CAGLE
Last Name:BRYDA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:KATHARINE
Other - Middle Name:ANN
Other - Last Name:CAGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1920 TIENDA DRIVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242
Mailing Address - Country:US
Mailing Address - Phone:209-747-6263
Mailing Address - Fax:209-543-1869
Practice Address - Street 1:1920 TIENDA DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242
Practice Address - Country:US
Practice Address - Phone:209-747-6263
Practice Address - Fax:209-543-1869
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF68655101YM0800X
106H00000X
CA51821106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health