Provider Demographics
NPI:1003147638
Name:DEAN, KATHARINE MARY (M C)
Entity Type:Individual
Prefix:MS
First Name:KATHARINE
Middle Name:MARY
Last Name:DEAN
Suffix:
Gender:F
Credentials:M C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5265 N TIGUA DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-3739
Mailing Address - Country:US
Mailing Address - Phone:520-544-0646
Mailing Address - Fax:
Practice Address - Street 1:4500 N PASEO BOCOANCOS
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85750-1702
Practice Address - Country:US
Practice Address - Phone:520-544-0646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-21
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-10950101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional