Provider Demographics
NPI:1285462242
Name:PREWITT, KATHERINE REYNOLDS
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:REYNOLDS
Last Name:PREWITT
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 1:874 DUNN STORE RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42261-8271
Mailing Address - Country:US
Mailing Address - Phone:270-799-2690
Mailing Address - Fax:
Practice Address - Street 1:1312 WESTEN ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3352
Practice Address - Country:US
Practice Address - Phone:270-904-1072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health