Basic Information
| Provider Information | |||||||||
| NPI: | 1598881500 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LISTER | ||||||||
| FirstName: | CATHERINE | ||||||||
| MiddleName: | ELBA | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M. S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7321 ZACHAU PL | ||||||||
| Address2: | |||||||||
| City: | TUJUNGA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910421320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189511453 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6800 OWENSMOUTH AVE | ||||||||
| Address2: | |||||||||
| City: | CANOGA PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913033159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183478565 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | IMF 48002 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.