Provider Demographics
NPI:1790203438
Name:COUGHLIN, KATELIN ANNE (LMHC)
Entity Type:Individual
Prefix:MS
First Name:KATELIN
Middle Name:ANNE
Last Name:COUGHLIN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:SOUTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01550-3795
Mailing Address - Country:US
Mailing Address - Phone:508-519-3523
Mailing Address - Fax:
Practice Address - Street 1:328 MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:SOUTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01550-3795
Practice Address - Country:US
Practice Address - Phone:508-519-3523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-01
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13506101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health