Provider Demographics
NPI:1073384566
Name:HATHAWAY, KATIE ELIZABETH (LPC-A)
Entity Type:Individual
Prefix:MS
First Name:KATIE
Middle Name:ELIZABETH
Last Name:HATHAWAY
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7850 FM 3104
Mailing Address - Street 2:
Mailing Address - City:WHEELER
Mailing Address - State:TX
Mailing Address - Zip Code:79096-7505
Mailing Address - Country:US
Mailing Address - Phone:806-683-5029
Mailing Address - Fax:
Practice Address - Street 1:901 S SWEETWATER ST
Practice Address - Street 2:
Practice Address - City:WHEELER
Practice Address - State:TX
Practice Address - Zip Code:79096-2428
Practice Address - Country:US
Practice Address - Phone:806-683-5029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX90237101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty