Provider Demographics
NPI:1447804935
Name:HABGOOD, KATIE (LAC)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:HABGOOD
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W OLD LINDEN RD
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-4608
Mailing Address - Country:US
Mailing Address - Phone:928-537-6150
Mailing Address - Fax:
Practice Address - Street 1:761 E MCNEIL
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-5962
Practice Address - Country:US
Practice Address - Phone:928-537-6150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-01
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-18227101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health