Provider Demographics
NPI:1457974768
Name:HABIG, KATHLEEN A (LPC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:HABIG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7721 S 68TH DR
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-2751
Mailing Address - Country:US
Mailing Address - Phone:520-550-6401
Mailing Address - Fax:
Practice Address - Street 1:4577 W PECOS RD
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-9002
Practice Address - Country:US
Practice Address - Phone:520-550-6401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-20
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-16987101YP2500X
LPC-21584101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional