Provider Demographics
NPI:1497265383
Name:LEATHAM, CATHERINE ANN (BACHELOR OF SCIENCE)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ANN
Last Name:LEATHAM
Suffix:
Gender:F
Credentials:BACHELOR OF SCIENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 N 180 W
Mailing Address - Street 2:
Mailing Address - City:EPHRAIM
Mailing Address - State:UT
Mailing Address - Zip Code:84627-2130
Mailing Address - Country:US
Mailing Address - Phone:435-283-0164
Mailing Address - Fax:435-283-2213
Practice Address - Street 1:66 N 180 W
Practice Address - Street 2:
Practice Address - City:EPHRAIM
Practice Address - State:UT
Practice Address - Zip Code:84627-2130
Practice Address - Country:US
Practice Address - Phone:435-283-0164
Practice Address - Fax:435-283-2213
Is Sole Proprietor?:No
Enumeration Date:2017-10-05
Last Update Date:2017-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1467745941Medicaid
UT1801104054Medicaid