Provider Demographics
NPI:1730279282
Name:LETHEBY, KATRINA ANNE (MS)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:ANNE
Last Name:LETHEBY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 MALLARD LANE
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68801
Mailing Address - Country:US
Mailing Address - Phone:308-383-9254
Mailing Address - Fax:
Practice Address - Street 1:329 MALLARD LN
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68801-8544
Practice Address - Country:US
Practice Address - Phone:308-383-9254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7679101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health