Provider Demographics
NPI:1154663201
Name:WOOTEN, KATHERINE B (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:B
Last Name:WOOTEN
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 1:3703 HIGHLAND PARK PL
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-6133
Mailing Address - Country:US
Mailing Address - Phone:901-320-3079
Mailing Address - Fax:
Practice Address - Street 1:3703 HIGHLAND PARK PL
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-6133
Practice Address - Country:US
Practice Address - Phone:901-320-3079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000051231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical