Provider Demographics
NPI:1144861642
Name:STREETER, KATIE (LMHC)
Entity type:Individual
Prefix:DR
First Name:KATIE
Middle Name:
Last Name:STREETER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 BERRY RD
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:12117-3608
Mailing Address - Country:US
Mailing Address - Phone:757-705-9251
Mailing Address - Fax:
Practice Address - Street 1:265 BERRY RD
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:NY
Practice Address - Zip Code:12117-3608
Practice Address - Country:US
Practice Address - Phone:757-705-9251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-05
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
NY009543101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No251S00000XAgenciesCommunity/Behavioral Health