Provider Demographics
NPI:1083078380
Name:BROWN, KATHLEEN HARDISON (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:HARDISON
Last Name:BROWN
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 1:100 SUNNY LN
Mailing Address - Street 2:
Mailing Address - City:GATESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76528-1851
Mailing Address - Country:US
Mailing Address - Phone:254-248-1020
Mailing Address - Fax:
Practice Address - Street 1:113 S 7TH ST
Practice Address - Street 2:
Practice Address - City:GATESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76528-2011
Practice Address - Country:US
Practice Address - Phone:254-865-9911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69967101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX101YM0800XMedicaid