Provider Demographics
NPI:1407416498
Name:NULL, CATHERINE MICHELLE (LPC/MHSP)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:MICHELLE
Last Name:NULL
Suffix:
Gender:F
Credentials:LPC/MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5589 HINTON AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-7041
Mailing Address - Country:US
Mailing Address - Phone:901-825-8572
Mailing Address - Fax:
Practice Address - Street 1:2305 MCVAY RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-4823
Practice Address - Country:US
Practice Address - Phone:901-825-8572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000004078101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional