Provider Demographics
NPI: | 1033133376 |
---|---|
Name: | SEALE, KATHRINE ANNE (PSYD, PA) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | KATHRINE |
Middle Name: | ANNE |
Last Name: | SEALE |
Suffix: | |
Gender: | F |
Credentials: | PSYD, PA |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | PO BOX 806 |
Mailing Address - Street 2: | |
Mailing Address - City: | COMFORT |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 78013-0806 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 830-257-2777 |
Mailing Address - Fax: | 830-995-2565 |
Practice Address - Street 1: | 2404 MEMORIAL BLVD STE C-08 |
Practice Address - Street 2: | |
Practice Address - City: | KERRVILLE |
Practice Address - State: | TX |
Practice Address - Zip Code: | 78028-5630 |
Practice Address - Country: | US |
Practice Address - Phone: | 830-257-2777 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2006-07-27 |
Last Update Date: | 2007-07-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | 025622 | 103TC0700X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | 0029CT | Other | BLUE CROSS BLUE SHIELD |
TX | 44602 | Other | NATIONAL REGISTER OF HEAL |
TX | 0029CT | Other | BLUE CROSS BLUE SHIELD |
TX | 00137E | Medicare ID - Type Unspecified | MEDICARE |