Provider Demographics
NPI:1962755207
Name:FURTON, KATIE MARIE (LP)
Entity type:Individual
Prefix:DR
First Name:KATIE
Middle Name:MARIE
Last Name:FURTON
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15642 GARRISON LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-3446
Mailing Address - Country:US
Mailing Address - Phone:734-637-6152
Mailing Address - Fax:
Practice Address - Street 1:29887 W 11 MILE RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-1309
Practice Address - Country:US
Practice Address - Phone:734-637-6152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301019178103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6301019178OtherCLINICAL PSYCHOLOGIST