Provider Demographics
NPI:1861470056
Name:KATON, LAURIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:
Last Name:KATON
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 1:451 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-5813
Mailing Address - Country:US
Mailing Address - Phone:928-541-9826
Mailing Address - Fax:
Practice Address - Street 1:340 N MOUNT VERNON AVE
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-2620
Practice Address - Country:US
Practice Address - Phone:928-445-8393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-06
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ124301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ121191OtherMEDICARE PTAN