Basic Information
| Provider Information | |||||||||
| NPI: | 1366916785 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLUNGA | ||||||||
| FirstName: | KATIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1630 S BARRANCA AVE SPC 31 | ||||||||
| Address2: | |||||||||
| City: | GLENDORA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917405419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613198673 | ||||||||
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| Practice Location | |||||||||
| Address1: | 867 N FAIR OAKS AVE | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911033050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6267986793 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2019 | ||||||||
| LastUpdateDate: | 05/28/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 109241 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 225400000X | N | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner | 106H00000X | 130455 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.