Katherine Elizabeth Clark, MFT
Individual provider Active NPI Marriage & Family Therapist · Solana Beach, CA
NPI 1982936837 · NPPES record last updated Feb 3, 2010
Key facts
- NPI
- 1982936837
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Marriage & Family Therapist 106H00000X
- License
- MFC47115 (CA)
- Practice address
- 125 N Acacia Ave
Suite 106
Solana Beach, CA 92075-1165 - Phone
- (858) 822-9046
- Fax
- (858) 792-3884
- NPI assigned
- Feb 3, 2010
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 18, 2024 through Jan 18, 2028
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MFC47115 | CA | MD | Marriage & Family Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | MFC47115 | CA | Yes |
Addresses
Primary practice location
125 N Acacia Ave
Suite 106
Solana Beach, CA 92075-1165
Mailing address
125 N Acacia Ave
Suite 106
Solana Beach, CA 92075-1165
Phone (858) 822-9046
Other providers in Solana Beach, CA
- Marybeth Chruden
- Chrysalis Rising Programs
- Aliza Danielle Cicerone
- David Andrew Cisneros
- Amelia Rose Clark
- Kate Rose Clarke
- Hailey Clifford
- Cloe
- Coast Podiatry Group of Solana Beach Inc.
- Coast Podiatry Group of Solana Beach, Inc.
All providers in Solana Beach, CA · Marriage & Family Therapist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 3, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.