Provider Demographics
NPI:1750660494
Name:PEMBLETON, KATIE J (LCMFT)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:J
Last Name:PEMBLETON
Suffix:
Gender:F
Credentials:LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 ADAM TRAVIS CT
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-7116
Mailing Address - Country:US
Mailing Address - Phone:785-508-2008
Mailing Address - Fax:
Practice Address - Street 1:1402 ADAM TRAVIS CT
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-7116
Practice Address - Country:US
Practice Address - Phone:785-508-2008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-11
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS897106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist