Provider Demographics
NPI:1063713618
Name:LEVERETTE, KATRINA (LBSW)
Entity type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:
Last Name:LEVERETTE
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4402 FAWN DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-4411
Mailing Address - Country:US
Mailing Address - Phone:254-526-6444
Mailing Address - Fax:
Practice Address - Street 1:4402 FAWN DR
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-4411
Practice Address - Country:US
Practice Address - Phone:354-526-6444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-14
Last Update Date:2010-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50970171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator