Provider Demographics
NPI:1538396593
Name:POLAND, KATHERINE (MS, LMFT)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:
Last Name:POLAND
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:CLAIRE
Other - Last Name:WELCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LMFT
Mailing Address - Street 1:180 S LAKE AVE STE 340
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-5905
Mailing Address - Country:US
Mailing Address - Phone:626-502-3736
Mailing Address - Fax:
Practice Address - Street 1:180 S LAKE AVE STE 340
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-5905
Practice Address - Country:US
Practice Address - Phone:626-502-3736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-17
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF # 81902106H00000X
225400000X
CA102497106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7544Medicaid