Provider Demographics
NPI:1336811330
Name:MAGRUDER, KATIE LYNN (LCPC)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:LYNN
Last Name:MAGRUDER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 GLENN ST STE 302
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-2583
Mailing Address - Country:US
Mailing Address - Phone:240-580-1919
Mailing Address - Fax:
Practice Address - Street 1:200 GLENN ST STE 302
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2583
Practice Address - Country:US
Practice Address - Phone:240-580-1919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-29
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP11914101YM0800X
MDLC14174101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health