Provider Demographics
NPI:1497795645
Name:KATZ, LAWRENCE C (PH D)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:C
Last Name:KATZ
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 E MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:AL
Mailing Address - Zip Code:36340-1615
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1275 JAMES DR
Practice Address - Street 2:SUITE A
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-2063
Practice Address - Country:US
Practice Address - Phone:334-308-1940
Practice Address - Fax:334-308-1942
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL962103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL890015460Medicaid
AL051554131OtherCAHABA GBA
AL51524148OtherBLUE CROSS BLUE SHIELD
AL51524148OtherBLUE CROSS BLUE SHIELD