Provider Demographics
NPI:1962644427
Name:DAVIS, KATHERINE VERLINE (LPC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:VERLINE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 E. 21ST STREET
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-4729
Mailing Address - Country:US
Mailing Address - Phone:307-233-0549
Mailing Address - Fax:
Practice Address - Street 1:1607 CY AVENUE
Practice Address - Street 2:SUITE 102
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604-3571
Practice Address - Country:US
Practice Address - Phone:307-337-4673
Practice Address - Fax:307-337-4674
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-30
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC-1064101YM0800X
WY1064101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor