MEDICARE: KATHERINE GRANBERRY LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	61554	TX

General Provider Information

NPI Number	:	1477870624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE GRANBERRY LPC

Provider Business Mailing Address
First Line	:	PO BOX 92041
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78709-2041
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	385 CREEK RD
Second Line	:
City	:	DRIPPING SPRINGS
State	:	TX
Zip	:	78620-3439
Country	:	US
Telephone Number	:	512-797-4860
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2010
Last Update Date	:	10/21/2021

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