Provider Demographics
NPI:1982732004
Name:DORCH, KATHY L
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:L
Last Name:DORCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:L
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EDD, LMHC, LPC,
Mailing Address - Street 1:RR 3 BOX 9177
Mailing Address - Street 2:
Mailing Address - City:DONIPHAN
Mailing Address - State:MO
Mailing Address - Zip Code:63935-8758
Mailing Address - Country:US
Mailing Address - Phone:850-712-6699
Mailing Address - Fax:
Practice Address - Street 1:17901 CAUFIELD RD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34610-3013
Practice Address - Country:US
Practice Address - Phone:850-712-6699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
FLMH 11059101YM0800X
MO2012029826101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL761376800Medicaid