Provider Demographics
NPI:1588431027
Name:DEFER, KATHARINE G (LAC)
Entity type:Individual
Prefix:
First Name:KATHARINE
Middle Name:G
Last Name:DEFER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1535 N SCOTTSDALE RD APT 3103
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85288-1596
Mailing Address - Country:US
Mailing Address - Phone:162-357-0285
Mailing Address - Fax:
Practice Address - Street 1:6811 E SUPERSTITION SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-4001
Practice Address - Country:US
Practice Address - Phone:623-570-2859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-22099101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor