Katie Patrick Christides, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C8518 Issued in MS

Practice address

7075 Golden Oaks Loop W Ste 8
Southaven, MS 38671-9011

Phone

(901) 483-1086

NPI assigned

Jul 22, 2014

Last updated

Jan 18, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Apr 1, 2024 through Apr 1, 2028

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• New Leaf Counseling, Inc

  • Clinical Social Worker
  • Southaven, MS
  • NPI 1306362405
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1405987200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642464000000",
    "number": "1750798724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7075 GOLDEN OAKS LOOP W STE 8",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386719011",
            "telephone_number": "901-483-1086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7075 GOLDEN OAKS LOOP W STE 8",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386719011",
            "telephone_number": "901-483-1086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHRISTIDES",
        "first_name": "KATIE",
        "middle_name": "PATRICK",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-22",
        "last_updated": "2022-01-18",
        "certification_date": "2021-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TN",
            "license": "5994",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MS",
            "license": "C8518",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q006994",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shaunder Chillis, RN
• Chiropractic Wellness Centre, PLLC
• Ashley B Chittenden, CPNP-AC/PC
• Claiborne Ashby Christian, M.D.
• Richard Christian, DNP
• City Home Care, LLC
• City Home Care, LLC
• City Home Care, LLC
• City of Southaven (Southaven Fire Department Ambulance Service)
• Alisha Shavon Clark, PT

• Clinical Social Worker in Southaven, MS
• Providers in Southaven, MS by specialty
• Clinical Social Worker in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.