Provider Demographics
NPI:1720505456
Name:ZACHARY, KATRINA R
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:R
Last Name:ZACHARY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3646 N HIGH POINT CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-3428
Mailing Address - Country:US
Mailing Address - Phone:913-488-7939
Mailing Address - Fax:
Practice Address - Street 1:900 N POPLAR ST STE 103
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-1968
Practice Address - Country:US
Practice Address - Phone:316-803-1011
Practice Address - Fax:316-803-1754
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-24
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2886106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist