Healthcare Provider Details

I. General information

NPI: 1497795645
Provider Name (Legal Business Name): LAWRENCE C KATZ PH. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 09/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 JAMES DR SUITE A
ENTERPRISE AL
36330-2063
US

IV. Provider business mailing address

105 E MAPLE AVE
GENEVA AL
36340-1615
US

V. Phone/Fax

Practice location:
  • Phone: 334-308-1940
  • Fax: 334-308-1942
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number962
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: