Provider Demographics
NPI:1063648723
Name:WOMANSONG, KATHLEEN (LPC LCDC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:WOMANSONG
Suffix:
Gender:F
Credentials:LPC LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5604 SOUTHWEST PARKWAY
Mailing Address - Street 2:2521
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-6273
Mailing Address - Country:US
Mailing Address - Phone:512-363-6552
Mailing Address - Fax:
Practice Address - Street 1:5604 SOUTHWEST PARKWAY
Practice Address - Street 2:2521
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-6273
Practice Address - Country:US
Practice Address - Phone:512-363-6552
Practice Address - Fax:512-532-6500
Is Sole Proprietor?:No
Enumeration Date:2009-06-08
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64788101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX202048901Medicaid