Provider Demographics
NPI:1497113864
Name:RAE, KATHARINE ELIZABETH I (LPC)
Entity Type:Individual
Prefix:MISS
First Name:KATHARINE
Middle Name:ELIZABETH
Last Name:RAE
Suffix:I
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 1:1800 COMMUNITY
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MO
Mailing Address - Zip Code:64735-8804
Mailing Address - Country:US
Mailing Address - Phone:660-885-8131
Mailing Address - Fax:
Practice Address - Street 1:227 METRO DR
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-1134
Practice Address - Country:US
Practice Address - Phone:888-403-1071
Practice Address - Fax:573-634-4010
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-01
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016002279101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional