Provider Demographics
NPI:1336234996
Name:MIERS, KATHRYN DENISE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:DENISE
Last Name:MIERS
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 1:18445 HWY 105 W
Mailing Address - Street 2:STE 102 PMB 215
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356
Mailing Address - Country:US
Mailing Address - Phone:936-443-8092
Mailing Address - Fax:936-342-9081
Practice Address - Street 1:18445 HWY 105 W
Practice Address - Street 2:STE 102 PMB 215
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356
Practice Address - Country:US
Practice Address - Phone:936-443-8092
Practice Address - Fax:936-342-9081
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19016101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX266499Medicaid
TX84641LOtherBLUE CROSS BLUE SHIELD
TX174737004Medicaid
TX174737003Medicaid
TX84846LOtherBLUE CROSS BLUE SHIELD