Provider Demographics
NPI:1790973345
Name:PARADISE, KATHY L (LPC)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:L
Last Name:PARADISE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3031 I H 10 W
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-5159
Mailing Address - Country:US
Mailing Address - Phone:210-731-1300
Mailing Address - Fax:210-731-1310
Practice Address - Street 1:806 S ZARZAMORA ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-5362
Practice Address - Country:US
Practice Address - Phone:210-731-1300
Practice Address - Fax:210-434-0716
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16466101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX16466OtherLIC PROFFESIONAL COUNSELO