Provider Demographics
NPI:1740867928
Name:KINGRA, KATHERINE D (LMHC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:D
Last Name:KINGRA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:D
Other - Last Name:SZUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:44 MILL ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:NY
Mailing Address - Zip Code:14882-8916
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:44 MILL ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:NY
Practice Address - Zip Code:14882-8916
Practice Address - Country:US
Practice Address - Phone:207-409-2143
Practice Address - Fax:207-409-2143
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP109072101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health