Provider Demographics
NPI:1407444011
Name:DEEN, KAITLIN (MS, LPC)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:DEEN
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 WINDSOR DR
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:TX
Mailing Address - Zip Code:76179-6353
Mailing Address - Country:US
Mailing Address - Phone:817-312-1021
Mailing Address - Fax:
Practice Address - Street 1:4516 BOAT CLUB RD STE 106
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135-7020
Practice Address - Country:US
Practice Address - Phone:817-238-0106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81393101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health