Provider Demographics
NPI:1093722415
Name:COON, CATHERINE L (LP, RPT)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:L
Last Name:COON
Suffix:
Gender:F
Credentials:LP, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 RICHARD ST
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-5621
Mailing Address - Country:US
Mailing Address - Phone:870-918-5989
Mailing Address - Fax:
Practice Address - Street 1:1208 RICHARD ST
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-5621
Practice Address - Country:US
Practice Address - Phone:870-918-5989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR06-09E101Y00000X
AR08-17P103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR116399726Medicaid
AR1093722415OtherBCBS