Provider Demographics
NPI:1750412094
Name:BERNE, KATRINA H (PHD)
Entity type:Individual
Prefix:DR
First Name:KATRINA
Middle Name:H
Last Name:BERNE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 31 BOX 1225
Mailing Address - Street 2:
Mailing Address - City:HAPPY JACK
Mailing Address - State:AZ
Mailing Address - Zip Code:86024-9705
Mailing Address - Country:US
Mailing Address - Phone:928-477-2759
Mailing Address - Fax:928-477-2759
Practice Address - Street 1:HC 31 BOX 1225
Practice Address - Street 2:
Practice Address - City:HAPPY JACK
Practice Address - State:AZ
Practice Address - Zip Code:86024-9705
Practice Address - Country:US
Practice Address - Phone:928-477-2759
Practice Address - Fax:928-477-2759
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1603103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical