Provider Demographics
NPI:1841685542
Name:KATKE, KATHY ANN (LPC CMPH QMPH QIDP)
Entity type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:ANN
Last Name:KATKE
Suffix:
Gender:F
Credentials:LPC CMPH QMPH QIDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 S OTSEGO AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-2708
Mailing Address - Country:US
Mailing Address - Phone:248-318-6360
Mailing Address - Fax:
Practice Address - Street 1:814 S OTSEGO AVE
Practice Address - Street 2:SUITE E
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-2708
Practice Address - Country:US
Practice Address - Phone:248-318-6360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-31
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014774101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health