Provider Demographics
NPI:1639737794
Name:FAIRCHILD, KATRINA ANNA (LPC)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:ANNA
Last Name:FAIRCHILD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:ANNA
Other - Last Name:AUWAERTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3613 WILLIAMS DR STE 1005
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-1376
Mailing Address - Country:US
Mailing Address - Phone:737-279-4700
Mailing Address - Fax:737-279-4500
Practice Address - Street 1:3613 WILLIAMS DR STE 1005
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-1376
Practice Address - Country:US
Practice Address - Phone:737-279-4700
Practice Address - Fax:737-279-4500
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-04
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74634101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX74634OtherTEXAS STATE BOARD OF EXAMINERS OF PROFESSIONAL COUNSELORS