Provider Demographics
NPI:1134127350
Name:LA GRANGE, KATHERYN ELIZABETH (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHERYN
Middle Name:ELIZABETH
Last Name:LA GRANGE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KATHERYN
Other - Middle Name:ELIZABETH
Other - Last Name:CHRISTIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:6350 W ANDREW JOHNSON HWY
Mailing Address - Street 2:
Mailing Address - City:TALBOTT
Mailing Address - State:TN
Mailing Address - Zip Code:37877-8605
Mailing Address - Country:US
Mailing Address - Phone:800-355-3565
Mailing Address - Fax:423-714-2355
Practice Address - Street 1:2018 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37921
Practice Address - Country:US
Practice Address - Phone:865-544-0406
Practice Address - Fax:865-544-0480
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW40571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3497533Medicaid
TN3923755Medicaid
TN4058480OtherBCBS