Provider Demographics
NPI:1184305922
Name:DALUM, KATHIE
Entity type:Individual
Prefix:
First Name:KATHIE
Middle Name:
Last Name:DALUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4441 OLD COLLEGE RD APT 7103
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77801-3534
Mailing Address - Country:US
Mailing Address - Phone:979-739-4385
Mailing Address - Fax:
Practice Address - Street 1:23 MELLEN ST FL 5
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-2757
Practice Address - Country:US
Practice Address - Phone:857-331-6331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALMHC10000663101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health