Provider Demographics
NPI:1871756338
Name:YATES, KATHERINE K (MFT)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:K
Last Name:YATES
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 1:99 PEPPER LN
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-9611
Mailing Address - Country:US
Mailing Address - Phone:707-794-7954
Mailing Address - Fax:
Practice Address - Street 1:99 PEPPER LN
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-9611
Practice Address - Country:US
Practice Address - Phone:707-794-7954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-04
Last Update Date:2008-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT15038106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist