Basic Information
| Provider Information | |||||||||
| NPI: | 1679116974 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ST. GEORGE | ||||||||
| FirstName: | KATHERINE | ||||||||
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| Credential: | MA, LPC, ATR-P | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5524 BEE CAVES RD STE K4 | ||||||||
| Address2: | |||||||||
| City: | WEST LAKE HILLS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787465247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5127100551 | ||||||||
| FaxNumber: | 5127176337 | ||||||||
| Practice Location | |||||||||
| Address1: | 14101 W HWY 290 STE 100 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787379332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5127100551 | ||||||||
| FaxNumber: | 5127176337 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2019 | ||||||||
| LastUpdateDate: | 07/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 221700000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Art Therapist | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.