Provider Demographics
NPI:1366756827
Name:NUTTER, KATHRYN S (LPC)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:S
Last Name:NUTTER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 52
Mailing Address - Street 2:
Mailing Address - City:SUBLIME
Mailing Address - State:TX
Mailing Address - Zip Code:77986-0052
Mailing Address - Country:US
Mailing Address - Phone:361-772-3737
Mailing Address - Fax:
Practice Address - Street 1:1324 N AVE E
Practice Address - Street 2:
Practice Address - City:SHINER
Practice Address - State:TX
Practice Address - Zip Code:77984-6284
Practice Address - Country:US
Practice Address - Phone:361-772-3737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20047101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional