Caitlin M Harley, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C9867 Issued in MS

Practice address

1310 Goodman Rd E
Southaven, MS 38671-9542

Phone

(662) 470-5433

Fax

(501) 745-2378

NPI assigned

Jul 20, 2022

Last updated

Aug 17, 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 1

Addresses

Other identifiers 1

Other names 1

• Caitlin M Kuttenkuler Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1658275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660694400000",
    "number": "1962137315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1310 GOODMAN RD E",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386719542",
            "telephone_number": "662-470-5433",
            "fax_number": "501-745-2378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 GOODMAN RD E",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386719542",
            "telephone_number": "662-470-5433",
            "fax_number": "501-745-2378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARLEY",
        "first_name": "CAITLIN",
        "middle_name": "M",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-20",
        "last_updated": "2022-08-17",
        "certification_date": "2022-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MS",
            "license": "C9867",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LCSW LICENSE",
            "identifier": "C9867",
            "state": "MS"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "caitlin@soulshineheal.com",
            "affiliation": "N",
            "endpointDescription": "Business Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1310 Goodman Rd E",
            "city": "Southaven",
            "state": "MS",
            "country_code": "US",
            "postal_code": "386719542",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "CAITLIN",
            "last_name": "KUTTENKULER",
            "middle_name": "M",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• William George Hanley, OTR
• Charles Edwin Harbison, DDS
• William Taylor Hardy, DNP
• Ava Kristen Harmon, OTR/L
• Harmony Health, PLLC
• Erin Elizabeth Harrington, DNP, FNP-BC
• Jamieka Harris, LMSW
• Jennifer Harris

• 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 Aug 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.