MEDICARE: TAKE A BREAK WITH KATE LLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1821756974
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAKE A BREAK WITH KATE LLC

Provider Business Mailing Address
First Line	:	2922 MID LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-4912
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2922 MID LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-4912
Country	:	US
Telephone Number	:	713-444-2647
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KATHRYN DOHERTY
Credential	:	LCSW
Telephone Number	:	713-444-2647

Provider Enumeration Date	:	12/06/2021
Last Update Date	:	12/15/2021

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Directions to “TAKE A BREAK WITH KATE LLC ” Practice Location

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