Provider Demographics
NPI:1114183605
Name:KOHLER, KATIE
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:KOHLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 DEWEY AVE
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-3009
Mailing Address - Country:US
Mailing Address - Phone:864-585-0366
Mailing Address - Fax:864-598-9262
Practice Address - Street 1:189 S CONVERSE ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29306-3243
Practice Address - Country:US
Practice Address - Phone:864-582-5431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC121328Medicaid
SC121328Medicaid