Provider Demographics
NPI:1922476597
Name:OTTONE, KATHARINE (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:KATHARINE
Middle Name:
Last Name:OTTONE
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:DR
Other - First Name:KATHARINE
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, LPC
Mailing Address - Street 1:1933 BERKELEY PL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-1209
Mailing Address - Country:US
Mailing Address - Phone:817-266-8676
Mailing Address - Fax:
Practice Address - Street 1:2141 KIRKWOOD BLVD
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-1462
Practice Address - Country:US
Practice Address - Phone:817-266-8676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-12
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70470101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor