Provider Demographics
NPI:1679945224
Name:BOZEMAN, KATASHA JENE' (MS, LPC)
Entity type:Individual
Prefix:MRS
First Name:KATASHA
Middle Name:JENE'
Last Name:BOZEMAN
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:293 COLONIAL LANE
Mailing Address - Street 2:
Mailing Address - City:ODENVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35120
Mailing Address - Country:US
Mailing Address - Phone:205-356-6226
Mailing Address - Fax:
Practice Address - Street 1:924 MONTCLAIR RD STE 106
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35213-1210
Practice Address - Country:US
Practice Address - Phone:205-356-6226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-22
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3465101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional