Provider Demographics
NPI:1831233022
Name:ST.JOHN, KATHERINE MARIE (LCPC)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:MARIE
Last Name:ST.JOHN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:937 SANTA FE ST
Mailing Address - Street 2:
Mailing Address - City:ATCHISON
Mailing Address - State:KS
Mailing Address - Zip Code:66002-2334
Mailing Address - Country:US
Mailing Address - Phone:913-426-1225
Mailing Address - Fax:
Practice Address - Street 1:711 ARMSTRONG AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66101-2701
Practice Address - Country:US
Practice Address - Phone:913-233-3337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS249101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS17-4602Medicare ID - Type Unspecified
KS3620000Medicare ID - Type Unspecified