Provider Demographics
NPI:1053942532
Name:CROWN, KATHLEEN C H (LMFT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:C H
Last Name:CROWN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:KASEY
Other - Middle Name:
Other - Last Name:CROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:1112 MONTANA AVE # 266
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-1652
Mailing Address - Country:US
Mailing Address - Phone:310-913-8180
Mailing Address - Fax:
Practice Address - Street 1:329 N WETHERLY DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1605
Practice Address - Country:US
Practice Address - Phone:310-913-8180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80014106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist