Healthcare Provider Details

I. General information

NPI: 1639737794
Provider Name (Legal Business Name): KATRINA ANNA FAIRCHILD LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATRINA ANNA AUWAERTER

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3613 WILLIAMS DR STE 1005
GEORGETOWN TX
78628-1376
US

IV. Provider business mailing address

3613 WILLIAMS DR STE 1005
GEORGETOWN TX
78628-1376
US

V. Phone/Fax

Practice location:
  • Phone: 737-279-4700
  • Fax: 737-279-4500
Mailing address:
  • Phone: 737-279-4700
  • Fax: 737-279-4500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number74634
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: