1710252515 NPI number — MRS. KATHRYN NICOLE HUSEMAN LPC, NCC

Table of content: MRS. VICTORIA ELIZABETH MOSHOURES MD (NPI 1306845755)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710252515 NPI number — MRS. KATHRYN NICOLE HUSEMAN LPC, NCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUSEMAN
Provider First Name:
KATHRYN
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC, NCC
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:
1710252515
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
138 PARK AVE
Provider Second Line Business Mailing Address:
SUITE 214
Provider Business Mailing Address City Name:
WINDER
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30680-2118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-425-9007
Provider Business Mailing Address Fax Number:
678-425-9009

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
138 PARK AVE
Provider Second Line Business Practice Location Address:
SUITE 214
Provider Business Practice Location Address City Name:
WINDER
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30680-2118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-425-9007
Provider Business Practice Location Address Fax Number:
678-425-9009
Provider Enumeration Date:
03/13/2012

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: 101YP2500X , with the licence number:  LPC007388 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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