Provider Demographics
NPI:1083784151
Name:CHANEY, KATHERYN SUZANNE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KATHERYN
Middle Name:SUZANNE
Last Name:CHANEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14055 WATERFORD
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-7993
Mailing Address - Country:US
Mailing Address - Phone:972-564-9896
Mailing Address - Fax:
Practice Address - Street 1:14055 WATERFORD
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-7993
Practice Address - Country:US
Practice Address - Phone:972-564-9896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX305061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical