Provider Demographics
NPI:1356423925
Name:WEST, KATHERINE WILCOX (MS LICENSED PROFESSI)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:WILCOX
Last Name:WEST
Suffix:
Gender:F
Credentials:MS LICENSED PROFESSI
Other - Prefix:MRS
Other - First Name:KATHERINE
Other - Middle Name:WILCOX
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS LICENSED MARRIAGE
Mailing Address - Street 1:5926 SOUTH STAPLES
Mailing Address - Street 2:SUITE D9
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-3843
Mailing Address - Country:US
Mailing Address - Phone:361-992-6811
Mailing Address - Fax:361-992-6835
Practice Address - Street 1:5926 SOUTH STAPLES
Practice Address - Street 2:SUITE D9
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-3843
Practice Address - Country:US
Practice Address - Phone:361-992-6811
Practice Address - Fax:361-992-6835
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11238101YP2500X
TX3497106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1937LCOtherBLUE CROSS BLUE SHIELD