Provider Demographics
NPI:1699366344
Name:WOOTEN, CATHERINE CODY (PHD, LPC)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:CODY
Last Name:WOOTEN
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 COUNTRY MDW
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-5791
Mailing Address - Country:US
Mailing Address - Phone:210-861-9542
Mailing Address - Fax:
Practice Address - Street 1:7201 BROADWAY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-3743
Practice Address - Country:US
Practice Address - Phone:210-861-9542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73175101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor