Provider Demographics
NPI:1710423553
Name:THAKKAR, KATHARINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHARINE
Middle Name:
Last Name:THAKKAR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 WILDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-3271
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:316 PHYSICS RD
Practice Address - Street 2:ROOM 151
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824-5604
Practice Address - Country:US
Practice Address - Phone:517-355-9564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301016420103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist