1720353402 NPI number — KATHARINE ELIZABETH ENGLER LMFT

Table of content: KATHARINE ELIZABETH ENGLER LMFT (NPI 1720353402)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720353402 NPI number — KATHARINE ELIZABETH ENGLER LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ENGLER
Provider First Name:
KATHARINE
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720353402
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3210 FAIRHILL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27612-3215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-256-0824
Provider Business Mailing Address Fax Number:
919-256-0833

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
309 WYCHE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27536-4246
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-438-2581
Provider Business Practice Location Address Fax Number:
252-438-6364
Provider Enumeration Date:
03/14/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  1495 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: 7076A , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1720353402 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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