Provider Demographics
NPI:1376045088
Name:HUETH, KATIE LYNN (MA, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:LYNN
Last Name:HUETH
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 BRICK BLVD.
Mailing Address - Street 2:BUILDING 4, SUITE 206B
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723
Mailing Address - Country:US
Mailing Address - Phone:732-477-0862
Mailing Address - Fax:732-477-0879
Practice Address - Street 1:74 BRICK BLVD.
Practice Address - Street 2:BUILDING 4, SUITE 206B
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723
Practice Address - Country:US
Practice Address - Phone:732-477-0862
Practice Address - Fax:732-477-0879
Is Sole Proprietor?:No
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00623700101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ37PC00623700OtherNJ CONSUMER AFFAIRS