Provider Demographics
NPI:1356421663
Name:POWERS, KATHERINE V (PHD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:V
Last Name:POWERS
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 1:371 ALEXANDER ST
Mailing Address - Street 2:PATIENT ACCOUNTING
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-4450
Mailing Address - Country:US
Mailing Address - Phone:901-218-5107
Mailing Address - Fax:
Practice Address - Street 1:371 ALEXANDER ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-4450
Practice Address - Country:US
Practice Address - Phone:901-218-5107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002962103TB0200X
TN2797103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA723260517AMedicaid