Provider Demographics
NPI:1043697774
Name:STARK, KATE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATE
Middle Name:
Last Name:STARK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:ELIZABETH
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1723 E SOUTHLAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6444
Mailing Address - Country:US
Mailing Address - Phone:682-292-7012
Mailing Address - Fax:
Practice Address - Street 1:1723 E SOUTHLAKE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6445
Practice Address - Country:US
Practice Address - Phone:682-292-7012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-01
Last Update Date:2022-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY.0004166103T00000X
CO101523103TS0200X
TX71112103TS0200X
TX37628103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool