Provider Demographics
NPI:1265561658
Name:RAWLS, KATHRYN MARIE (MA, LCPC)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MARIE
Last Name:RAWLS
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:MARIE
Other - Last Name:MERKEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA,LCPC
Mailing Address - Street 1:PO BOX 155
Mailing Address - Street 2:
Mailing Address - City:CHRISTOPHER
Mailing Address - State:IL
Mailing Address - Zip Code:62822-0155
Mailing Address - Country:US
Mailing Address - Phone:618-724-2401
Mailing Address - Fax:618-724-4628
Practice Address - Street 1:1007 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IL
Practice Address - Zip Code:62837-2308
Practice Address - Country:US
Practice Address - Phone:618-842-4470
Practice Address - Fax:618-842-3437
Is Sole Proprietor?:No
Enumeration Date:2007-03-03
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007778101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional