Provider Demographics
NPI:1821609744
Name:JOHNSON, KATHERINE PATRICIA
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:PATRICIA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 CLAFLIN RD
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-3415
Mailing Address - Country:US
Mailing Address - Phone:725-242-2236
Mailing Address - Fax:
Practice Address - Street 1:2001 CLAFLIN RD
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-3415
Practice Address - Country:US
Practice Address - Phone:725-242-2236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2023-09-14
Deactivation Date:2023-09-07
Deactivation Code:
Reactivation Date:2023-09-12
Provider Licenses
StateLicense IDTaxonomies
KSLMFT03540-T106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist