Provider Demographics
NPI:1104898808
Name:KETCHAM, KATHLEEN SHARON (MA,LMFT)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:SHARON
Last Name:KETCHAM
Suffix:
Gender:F
Credentials:MA,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 N 1ST ST
Mailing Address - Street 2:SUITE 54
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-2859
Mailing Address - Country:US
Mailing Address - Phone:360-336-2842
Mailing Address - Fax:360-336-2521
Practice Address - Street 1:117 N 1ST ST
Practice Address - Street 2:SUITE 54
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-2859
Practice Address - Country:US
Practice Address - Phone:360-336-2842
Practice Address - Fax:360-336-2521
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00001140106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist