Provider Demographics
NPI:1164970455
Name:DAMIN, CATHERINE
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:DAMIN
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 1:9100 OVERLAND PLZ
Mailing Address - Street 2:
Mailing Address - City:OVERLAND
Mailing Address - State:MO
Mailing Address - Zip Code:63114-6123
Mailing Address - Country:US
Mailing Address - Phone:314-744-9027
Mailing Address - Fax:
Practice Address - Street 1:201 NE PARK PLAZA DR STE 145
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5873
Practice Address - Country:US
Practice Address - Phone:360-729-8383
Practice Address - Fax:360-729-3534
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-14
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016031755101YM0800X
WALH60864160101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health