Provider Demographics
NPI:1912668823
Name:FENSTER, KATHRYN (LAC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:FENSTER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3009 N WEST ST FL 2
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-3444
Mailing Address - Country:US
Mailing Address - Phone:928-719-4009
Mailing Address - Fax:
Practice Address - Street 1:3009 N WEST ST FL 2
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-3444
Practice Address - Country:US
Practice Address - Phone:928-719-4009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-20501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health