Basic Information
| Provider Information | |||||||||
| NPI: | 1003017914 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FALLON | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5226 AVONDALE DR | ||||||||
| Address2: | |||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774793811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2816856921 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6500 CHIMNEY ROCK RD | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770814504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2816856921 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 12743 | TX | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.