Provider Demographics
NPI:1588255087
Name:VAN CLEAVE, KATHERINE PRIGMORE (MA, LPC-MHSP)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:PRIGMORE
Last Name:VAN CLEAVE
Suffix:
Gender:F
Credentials:MA, LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 LAKE ODONNELL RD
Mailing Address - Street 2:
Mailing Address - City:SEWANEE
Mailing Address - State:TN
Mailing Address - Zip Code:37375-2154
Mailing Address - Country:US
Mailing Address - Phone:423-364-3202
Mailing Address - Fax:
Practice Address - Street 1:885 LAKE ODONNELL RD
Practice Address - Street 2:
Practice Address - City:SEWANEE
Practice Address - State:TN
Practice Address - Zip Code:37375-2154
Practice Address - Country:US
Practice Address - Phone:423-364-3202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000004218101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health