Provider Demographics
NPI:1881454510
Name:JOSEPH, KATRINA AMANDA MARIE
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:AMANDA MARIE
Last Name:JOSEPH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 N BOWDISH RD APT C
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-5183
Mailing Address - Country:US
Mailing Address - Phone:406-210-7666
Mailing Address - Fax:
Practice Address - Street 1:4005 N COOK ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-5879
Practice Address - Country:US
Practice Address - Phone:509-530-4222
Practice Address - Fax:509-530-4235
Is Sole Proprietor?:No
Enumeration Date:2024-03-20
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61525501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health