Basic Information
| Provider Information | |||||||||
| NPI: | 1134195415 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEMAS | ||||||||
| FirstName: | KATENA | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 71079 ALDRICH LAKE RD | ||||||||
| Address2: | |||||||||
| City: | STURGIS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490919234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5742867745 | ||||||||
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| Practice Location | |||||||||
| Address1: | 403 E MADISON ST | ||||||||
| Address2: | |||||||||
| City: | SOUTH BEND | ||||||||
| State: | IN | ||||||||
| PostalCode: | 466172322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5742340061 | ||||||||
| FaxNumber: | 5742831209 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2006 | ||||||||
| LastUpdateDate: | 02/19/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 34004324A | IN | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.