Provider Demographics
NPI:1700186103
Name:KATHERINE THERRELL, LPC, PLLC
Entity Type:Organization
Organization Name:KATHERINE THERRELL, LPC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:BROWN
Authorized Official - Last Name:THERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MS LPC NCC
Authorized Official - Phone:828-687-0583
Mailing Address - Street 1:10 EAGLES ROOST LN
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-7571
Mailing Address - Country:US
Mailing Address - Phone:828-651-0111
Mailing Address - Fax:828-687-0583
Practice Address - Street 1:10 EAGLES ROOST LN
Practice Address - Street 2:
Practice Address - City:FLETCHER
Practice Address - State:NC
Practice Address - Zip Code:28732-7571
Practice Address - Country:US
Practice Address - Phone:828-651-0111
Practice Address - Fax:828-687-0583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4544101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103698Medicaid