Provider Demographics
NPI:1881116770
Name:TEBO, KATHERINE (LPC-S)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:TEBO
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10065 OLD HAMMOND HWY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-8256
Mailing Address - Country:US
Mailing Address - Phone:225-406-7643
Mailing Address - Fax:
Practice Address - Street 1:10065 OLD HAMMOND HWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-8256
Practice Address - Country:US
Practice Address - Phone:225-337-0390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-12
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6262101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty