Provider Demographics
NPI:1669822912
Name:HINES-LIGON, KATRINA (MA, MS, LPC)
Entity Type:Individual
Prefix:MS
First Name:KATRINA
Middle Name:
Last Name:HINES-LIGON
Suffix:
Gender:F
Credentials:MA, MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 SHILOH RD STE 1404
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-2436
Mailing Address - Country:US
Mailing Address - Phone:903-216-0414
Mailing Address - Fax:
Practice Address - Street 1:1820 SHILOH RD STE 1404
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-2436
Practice Address - Country:US
Practice Address - Phone:903-216-0414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-17
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69864101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional