| Doctor Name: | MRS. KATHELEEN JOAN HART |
| NPI Number: | 1750781688 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LLPC |
| License Number: | 6401014383 |
| Business Practice Address: | 3948 S. Straits Hwy South Building, Suite 1 Indian River, MI - 49749 |
| Business Phone Number: | 2312681707 |
| Business Fax Number: | |
| Mailing Address: | Po Box 324, INDIAN RIVER |
| State: | MI |
| Postal Code: | 497490324 |
| Phone Number: | 2312681707 |
| Fax Number: | |
| NPI Enumeration Date: | 08/28/2014 |
| NPI Last Update Date: | 08/28/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 6401014383 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |