Provider Demographics
NPI:1417664673
Name:REDISKE, KATHERINE E (MA, LPC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:E
Last Name:REDISKE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1629 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-5774
Mailing Address - Country:US
Mailing Address - Phone:512-695-9634
Mailing Address - Fax:
Practice Address - Street 1:1210 CORYELL CITY RD
Practice Address - Street 2:
Practice Address - City:GATESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76528-2913
Practice Address - Country:US
Practice Address - Phone:254-865-9398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75144101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health