Provider Demographics
NPI:1033346655
Name:DOUTHAT, KATHLEEN BRIEN (MED, LPC-MHSP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:BRIEN
Last Name:DOUTHAT
Suffix:
Gender:F
Credentials:MED, LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12211 ARONIMINK PT
Mailing Address - Street 2:
Mailing Address - City:FARRAGUT
Mailing Address - State:TN
Mailing Address - Zip Code:37934-2530
Mailing Address - Country:US
Mailing Address - Phone:865-804-4978
Mailing Address - Fax:
Practice Address - Street 1:10411 LOVELL CENTER DR STE 107
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3262
Practice Address - Country:US
Practice Address - Phone:865-804-4978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-22
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2461101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN12375144OtherCAQH PROVIDER ID