Provider Demographics
NPI:1942742218
Name:KATHRYN KLOCK-POWELL AND ASSOCIATES, LLC
Entity Type:Organization
Organization Name:KATHRYN KLOCK-POWELL AND ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:KLOCKPOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMFT, RPT-S
Authorized Official - Phone:912-441-5887
Mailing Address - Street 1:PO BOX 1421
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:GA
Mailing Address - Zip Code:31329-1421
Mailing Address - Country:US
Mailing Address - Phone:912-441-5887
Mailing Address - Fax:912-826-2996
Practice Address - Street 1:711 ZITTEROUR DR
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-9269
Practice Address - Country:US
Practice Address - Phone:912-441-5887
Practice Address - Fax:912-826-2996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-17
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1007106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty