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General NPI Number Information
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NPI Number | 1467911099
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Entity Type | Individual
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Provider Name | KATHLEEN HEARNE LPC
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Gender | Female
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Dates
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Enumeration Date | 03/13/2019
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Last Update Date | 04/28/2021
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Provider Practice Location Address
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Address Line | 40 E MITCHELL DR STE 100
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City | PHOENIX
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State | AZ
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Zip | 85012-2330
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Country | US
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Telephone | 602-599-5610
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Fax |
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Provider Business Mailing Address
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Address Line | 18444 N 25TH AVE STE 420
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City | PHOENIX
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State | AZ
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Zip | 85023-1268
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Country | US
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Telephone | 623-349-4344
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC-17930
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License Number State | AZ
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