Provider Demographics
NPI:1891838603
Name:PEATROSS, KATHERINE GOODLOE
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:GOODLOE
Last Name:PEATROSS
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 1:374 ROSELAND PL
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-7620
Mailing Address - Country:US
Mailing Address - Phone:901-786-8250
Mailing Address - Fax:
Practice Address - Street 1:3320 BROTHER BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38133-8950
Practice Address - Country:US
Practice Address - Phone:901-251-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1198101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional