Provider Demographics
NPI:1962171835
Name:WHITLOCK, KATHRYN ELIZABETH (ATR-BC, LPC, CCTP-II)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:ELIZABETH
Last Name:WHITLOCK
Suffix:
Gender:F
Credentials:ATR-BC, LPC, CCTP-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14411 KINGSTON ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-1141
Mailing Address - Country:US
Mailing Address - Phone:248-736-3347
Mailing Address - Fax:
Practice Address - Street 1:14411 KINGSTON ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-1141
Practice Address - Country:US
Practice Address - Phone:248-736-3347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451019659101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional