Provider Demographics
NPI:1265697064
Name:POWELL, KATHERINE RUTH (PHD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:RUTH
Last Name:POWELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2519
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95759-2519
Mailing Address - Country:US
Mailing Address - Phone:916-690-8343
Mailing Address - Fax:916-690-8343
Practice Address - Street 1:7632 CHATSWORTH CIR
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-5106
Practice Address - Country:US
Practice Address - Phone:916-690-8343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12410101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health