Provider Demographics
NPI:1326354986
Name:GREATHOUSE, KATHERINE A (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:A
Last Name:GREATHOUSE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:A
Other - Last Name:DECLUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2107 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-2242
Mailing Address - Country:US
Mailing Address - Phone:541-963-0602
Mailing Address - Fax:541-962-0345
Practice Address - Street 1:2107 3RD ST
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-2242
Practice Address - Country:US
Practice Address - Phone:541-963-0602
Practice Address - Fax:541-962-0345
Is Sole Proprietor?:No
Enumeration Date:2010-08-20
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL4398101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional