Provider Demographics
NPI:1336360569
Name:YARBOROUGH, KATHLEEN ANN (LPC, LCDC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANN
Last Name:YARBOROUGH
Suffix:
Gender:F
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 625
Mailing Address - Street 2:
Mailing Address - City:SEADRIFT
Mailing Address - State:TX
Mailing Address - Zip Code:77983
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:905 WEST WASHINGTON
Practice Address - Street 2:
Practice Address - City:SEADRIFT
Practice Address - State:TX
Practice Address - Zip Code:77983
Practice Address - Country:US
Practice Address - Phone:361-785-6075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15851101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional