Provider Demographics
NPI:1871542076
Name:LOLLAR, KATHERINE I (LCSW)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:I
Last Name:LOLLAR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 DEWBERRY LN
Mailing Address - Street 2:
Mailing Address - City:DIANA
Mailing Address - State:TX
Mailing Address - Zip Code:75640-3871
Mailing Address - Country:US
Mailing Address - Phone:903-777-3846
Mailing Address - Fax:
Practice Address - Street 1:109 W TYLER ST
Practice Address - Street 2:SUITE G
Practice Address - City:GILMER
Practice Address - State:TX
Practice Address - Zip Code:75644-2239
Practice Address - Country:US
Practice Address - Phone:903-680-2592
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX369581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX611172Medicare ID - Type UnspecifiedHEALTH CARE PROVIDER