Provider Demographics
NPI:1083096275
Name:DILLINGHAM, KATHERIN (LPC)
Entity Type:Individual
Prefix:
First Name:KATHERIN
Middle Name:
Last Name:DILLINGHAM
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 1:3536 BEE CAVES RD STE 300
Mailing Address - Street 2:
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5474
Mailing Address - Country:US
Mailing Address - Phone:979-421-0567
Mailing Address - Fax:
Practice Address - Street 1:3536 BEE CAVES RD STE 300
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5474
Practice Address - Country:US
Practice Address - Phone:979-421-0567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-24
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69649101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional