Provider Demographics
NPI:1851844963
Name:BURNS, KATHERINE MICHELLE BOWLING (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MICHELLE BOWLING
Last Name:BURNS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:MICHELLE
Other - Last Name:BOWLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 32526
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87594-2526
Mailing Address - Country:US
Mailing Address - Phone:505-988-8010
Mailing Address - Fax:
Practice Address - Street 1:826 CAMINO DE MONTE REY
Practice Address - Street 2:SUITE A6
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505
Practice Address - Country:US
Practice Address - Phone:505-988-8010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-26
Last Update Date:2022-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5652-P1041C0700X
NMSWB-2022-00071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical