Individual
KATHY SUE DUTRIDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
1540 W VAN BUREN ST, PHOENIX, AZ 85007-2414
(602) 252-7330
(602) 252-4797
Mailing address
202 E EARLL DR, SUITE 200, PHOENIX, AZ 85012-2647
(602) 599-5404
(602) 599-5704
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
LPC-16803
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LAC-13064
LAC LICENSE
AZ
Enumeration date
11/10/2014
Last updated
01/09/2024
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