Provider Demographics
NPI:1548979966
Name:WHITEHEAD, KATIE ELIZABETH (LCSW)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:ELIZABETH
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:ELIZABETH
Other - Last Name:EUBANK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:527 TUSKEGEE AIRMEN AVE
Mailing Address - Street 2:
Mailing Address - City:SHEPPARD AFB
Mailing Address - State:TX
Mailing Address - Zip Code:76311
Mailing Address - Country:US
Mailing Address - Phone:940-676-1694
Mailing Address - Fax:
Practice Address - Street 1:527 TUSKEGEE AIRMEN AVE BLDG 500
Practice Address - Street 2:
Practice Address - City:SHEPPARD AFB
Practice Address - State:TX
Practice Address - Zip Code:76311
Practice Address - Country:US
Practice Address - Phone:940-676-1847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-15
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX691521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical