Provider Demographics
NPI:1245451285
Name:WINTERS, KATHLEEN T, (LLP, LPC)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:T,
Last Name:WINTERS
Suffix:
Gender:F
Credentials:LLP, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3904 OTTAWA AVENUE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-1925
Mailing Address - Country:US
Mailing Address - Phone:269-349-9217
Mailing Address - Fax:
Practice Address - Street 1:218 W. WALNUT
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007
Practice Address - Country:US
Practice Address - Phone:269-344-7997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401006621101YP2500X
MI6301010885103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral