Provider Demographics
NPI:1457663858
Name:WILSON, KATHERINE MORGAN (PHD, LMFT, LPC, RNC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MORGAN
Last Name:WILSON
Suffix:
Gender:F
Credentials:PHD, LMFT, LPC, RNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 GRAMMONT ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-7457
Mailing Address - Country:US
Mailing Address - Phone:318-388-4030
Mailing Address - Fax:318-998-3999
Practice Address - Street 1:312 GRAMMONT ST
Practice Address - Street 2:SUITE 300
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7457
Practice Address - Country:US
Practice Address - Phone:318-388-4030
Practice Address - Fax:318-998-3999
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3140101YP2500X
LA1001106H00000X
LARN081340163W00000X
LA0278542-03163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No163W00000XNursing Service ProvidersRegistered Nurse
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health