Provider Demographics
NPI:1124306709
Name:CABRERIZA, KATIE RAYE (LMHC)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:RAYE
Last Name:CABRERIZA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3510 50TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-2648
Mailing Address - Country:US
Mailing Address - Phone:319-213-4241
Mailing Address - Fax:
Practice Address - Street 1:818 W 1ST ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IA
Practice Address - Zip Code:52310-1307
Practice Address - Country:US
Practice Address - Phone:319-465-3727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-29
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001429101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA001429OtherLMHC LICENSE NUMBER