Provider Demographics
NPI:1982985081
Name:FRAZIER, KATHRYN RENEE (LPC-S, NCC)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:RENEE
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:LPC-S, NCC
Other - Prefix:MS
Other - First Name:KATHRYN
Other - Middle Name:RENEE
Other - Last Name:WINDAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6024 CAMMIE WAY
Mailing Address - Street 2:
Mailing Address - City:LEON VALLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78238-1602
Mailing Address - Country:US
Mailing Address - Phone:940-642-9195
Mailing Address - Fax:
Practice Address - Street 1:4203 WOODCOCK DR STE 216
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-1312
Practice Address - Country:US
Practice Address - Phone:210-564-9116
Practice Address - Fax:210-564-9087
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-01
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61241101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2854572-01Medicaid