Provider Demographics
NPI:1326337080
Name:CROOK, KATIE LYN (LPC)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:LYN
Last Name:CROOK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 C OF E DR
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-2556
Mailing Address - Country:US
Mailing Address - Phone:620-794-3996
Mailing Address - Fax:
Practice Address - Street 1:1420 C OF E DR
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-2556
Practice Address - Country:US
Practice Address - Phone:620-794-3996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2610101YP2500X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst