Provider Demographics
NPI:1699902973
Name:ZAVITZ, KATHRYN MICHELLE (LPCC)
Entity type:Individual
Prefix:MISS
First Name:KATHRYN
Middle Name:MICHELLE
Last Name:ZAVITZ
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10224 ELMHURST DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-4617
Mailing Address - Country:US
Mailing Address - Phone:505-604-5357
Mailing Address - Fax:
Practice Address - Street 1:10224 ELMHURST DR NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-4617
Practice Address - Country:US
Practice Address - Phone:505-604-5357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-15
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0146451101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM34305246Medicaid