Provider Demographics
NPI:1811550189
Name:JERAY, KATHARINE (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:
Last Name:JERAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11803 CLASSIC LN STE A
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-7077
Mailing Address - Country:US
Mailing Address - Phone:972-552-5559
Mailing Address - Fax:
Practice Address - Street 1:11803 CLASSIC LN STE A
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-7077
Practice Address - Country:US
Practice Address - Phone:972-552-5559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-22
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX832341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical