Provider Demographics
NPI:1063143113
Name:BRUSHABER, KATHRYN LEE
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:LEE
Last Name:BRUSHABER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:486 SPRING CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37083-4201
Mailing Address - Country:US
Mailing Address - Phone:615-561-6126
Mailing Address - Fax:
Practice Address - Street 1:486 SPRING CREEK RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:TN
Practice Address - Zip Code:37083-4201
Practice Address - Country:US
Practice Address - Phone:615-561-6126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21-171793106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician