Basic Information
| Provider Information | |||||||||
| NPI: | 1639278633 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KATUALA | ||||||||
| FirstName: | YVETTE | ||||||||
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| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2342 SHATTUCK AVE | ||||||||
| Address2: | 142 | ||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947041517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104994125 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2640 MARTIN LUTHER KING JR WAY | ||||||||
| Address2: | |||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947043238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5109815290 | ||||||||
| FaxNumber: | 5109815265 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2006 | ||||||||
| LastUpdateDate: | 07/17/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFC 40635 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.