Provider Demographics
NPI:1316303217
Name:VENA, KATIE (MS, LMHC)
Entity type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:
Last Name:VENA
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:491 ROXBURY RD
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-8016
Mailing Address - Country:US
Mailing Address - Phone:219-241-4419
Mailing Address - Fax:
Practice Address - Street 1:491 ROXBURY RD
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385-8016
Practice Address - Country:US
Practice Address - Phone:219-241-4419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-07
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002778A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health