Provider Demographics
NPI:1639320344
Name:DESHIELDS, KATIE BETH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KATIE
Middle Name:BETH
Last Name:DESHIELDS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 GARDINER LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-3003
Mailing Address - Country:US
Mailing Address - Phone:502-681-7330
Mailing Address - Fax:
Practice Address - Street 1:806 STONE CREEK PKWY STE 7
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-5394
Practice Address - Country:US
Practice Address - Phone:502-681-7330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-01
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY216350103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical