Provider Demographics
NPI:1952047896
Name:CORRICK, KATHERINE JANE (LMHC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:JANE
Last Name:CORRICK
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 E ROCKWOOD BLVD APT 315
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1200
Mailing Address - Country:US
Mailing Address - Phone:509-220-7999
Mailing Address - Fax:
Practice Address - Street 1:4324 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-1209
Practice Address - Country:US
Practice Address - Phone:509-315-8682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60238515101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALH60238515OtherMENTAL HEALTH LICENSE