Provider Demographics
NPI:1326345778
Name:KEITH, KATHY SHARP (LPC)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:SHARP
Last Name:KEITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:KATHY
Other - Middle Name:LOU
Other - Last Name:EDGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:21075 FOREST GROVE DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:TX
Mailing Address - Zip Code:75758-8225
Mailing Address - Country:US
Mailing Address - Phone:903-849-5297
Mailing Address - Fax:903-723-8252
Practice Address - Street 1:207 W PALESTINE AVE
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-7531
Practice Address - Country:US
Practice Address - Phone:903-849-5297
Practice Address - Fax:903-723-8252
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16919101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor