Provider Demographics
NPI:1164712089
Name:RUDY, KATHERINE CAROLINE (LMFT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:CAROLINE
Last Name:RUDY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 MUSIC VILLAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-2714
Mailing Address - Country:US
Mailing Address - Phone:615-824-3772
Mailing Address - Fax:615-447-1065
Practice Address - Street 1:105 MUSIC VILLAGE BLVD
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2714
Practice Address - Country:US
Practice Address - Phone:615-824-3772
Practice Address - Fax:615-447-1065
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN169101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health