Provider Demographics
NPI:1538190988
Name:KATIBLOO, NADINE (LMFT)
Entity type:Individual
Prefix:MISS
First Name:NADINE
Middle Name:
Last Name:KATIBLOO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 ABELIA
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-4517
Mailing Address - Country:US
Mailing Address - Phone:949-235-4858
Mailing Address - Fax:949-379-6520
Practice Address - Street 1:4010 BARRANCA PKWY STE 252
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-1716
Practice Address - Country:US
Practice Address - Phone:949-235-4858
Practice Address - Fax:949-379-6520
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44322106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist