Provider Demographics
NPI:1871083642
Name:KATHARINE USHER, INC.
Entity type:Organization
Organization Name:KATHARINE USHER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHARINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:USHER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:386-747-0687
Mailing Address - Street 1:1109 W EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-6553
Mailing Address - Country:US
Mailing Address - Phone:386-943-9040
Mailing Address - Fax:386-943-9937
Practice Address - Street 1:1109 W EUCLID AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-6553
Practice Address - Country:US
Practice Address - Phone:386-943-9040
Practice Address - Fax:386-943-9937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12075101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007338600Medicaid