Provider Demographics
NPI:1437175437
Name:GAZAWAY, KATHY J (LPC)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:J
Last Name:GAZAWAY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 W KINGSHIGHWAY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-3917
Mailing Address - Country:US
Mailing Address - Phone:870-236-2265
Mailing Address - Fax:870-215-0772
Practice Address - Street 1:2210 W. KINGSHIGHWAY
Practice Address - Street 2:SUITE 3
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450
Practice Address - Country:US
Practice Address - Phone:870-236-2265
Practice Address - Fax:870-215-0772
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP8803003101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5T388OtherBLUECROSS BLUESHIELD
5T388Medicare ID - Type Unspecified