Provider Demographics
NPI:1750651360
Name:KORNMAN, KATHRYN (LPC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:KORNMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:LANE
Other - Last Name:KORNMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:901 E 46TH ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85713-5008
Mailing Address - Country:US
Mailing Address - Phone:520-792-5704
Mailing Address - Fax:520-792-5724
Practice Address - Street 1:901 E 46TH ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713-5008
Practice Address - Country:US
Practice Address - Phone:520-792-5704
Practice Address - Fax:520-792-5724
Is Sole Proprietor?:No
Enumeration Date:2012-01-12
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-10606101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health