Provider Demographics
NPI:1568219111
Name:AHLGREEN, KATAVERA
Entity type:Individual
Prefix:
First Name:KATAVERA
Middle Name:
Last Name:AHLGREEN
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 1:6202 BAYVIEW LN
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-6581
Mailing Address - Country:US
Mailing Address - Phone:509-537-7166
Mailing Address - Fax:
Practice Address - Street 1:6202 BAYVIEW LN
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-6581
Practice Address - Country:US
Practice Address - Phone:509-537-7166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health