Provider Demographics
NPI:1083129704
Name:MCCURTER, KATHLEEN (MA)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:MCCURTER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:MCCURTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:PO BOX 301
Mailing Address - Street 2:
Mailing Address - City:BUCKNER
Mailing Address - State:MO
Mailing Address - Zip Code:64016-0301
Mailing Address - Country:US
Mailing Address - Phone:816-533-2791
Mailing Address - Fax:
Practice Address - Street 1:2209 N PONCA DR
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64058-1283
Practice Address - Country:US
Practice Address - Phone:816-533-2791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-04
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018004595101YP2500X
VT098.0133642TELE101YP2500X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT098.0133642TELEOtherSTATE OF VERMONT: PSYCHOANALYST INTERIM TELEHEALTH REGISTRATION
MO2018004595OtherMO LPC