Provider Demographics
NPI:1053492181
Name:MCGLYNN, KATHERINE MARIE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:MARIE
Last Name:MCGLYNN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7355 N. ORACLE ROAD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-6326
Mailing Address - Country:US
Mailing Address - Phone:520-304-2101
Mailing Address - Fax:520-219-8450
Practice Address - Street 1:7355 N. ORACLE ROAD
Practice Address - Street 2:SUITE 106
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-6326
Practice Address - Country:US
Practice Address - Phone:520-304-2101
Practice Address - Fax:520-219-8450
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1198101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
1117992OtherCIGNA VENDOR #