Provider Demographics
NPI:1972039006
Name:KO, KATE (LPC)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:
Last Name:KO
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 1:3419 ALTA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76706-4242
Mailing Address - Country:US
Mailing Address - Phone:281-433-0896
Mailing Address - Fax:
Practice Address - Street 1:4555 LAKE SHORE DR STE B
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-1814
Practice Address - Country:US
Practice Address - Phone:254-214-2334
Practice Address - Fax:254-776-0637
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-10
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73463101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional