Provider Demographics
NPI:1861682684
Name:BERLA', KATHRYN (EDD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:
Last Name:BERLA'
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8135 NEW LAGRANGE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4682
Mailing Address - Country:US
Mailing Address - Phone:502-412-2226
Mailing Address - Fax:502-423-1935
Practice Address - Street 1:8135 NEW LAGRANGE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4682
Practice Address - Country:US
Practice Address - Phone:502-412-2226
Practice Address - Fax:502-423-1935
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY1250103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling