Provider Demographics
NPI:1295021699
Name:KATKE, JEFFERY W (LPC CMHP QIDP CMHP)
Entity Type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:W
Last Name:KATKE
Suffix:
Gender:M
Credentials:LPC CMHP QIDP CMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 S OTSEGO AVE
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-2708
Mailing Address - Country:US
Mailing Address - Phone:248-318-6360
Mailing Address - Fax:231-941-8981
Practice Address - Street 1:814 S OTSEGO AVE
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-2708
Practice Address - Country:US
Practice Address - Phone:248-318-6360
Practice Address - Fax:231-941-8981
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012426101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health