Provider Demographics
NPI:1477212819
Name:DORSEY, KATIE ANNE
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:ANNE
Last Name:DORSEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 BANDERA HWY APT 620
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-8017
Mailing Address - Country:US
Mailing Address - Phone:325-226-0513
Mailing Address - Fax:
Practice Address - Street 1:1350 BANDERA HWY APT 620
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-8017
Practice Address - Country:US
Practice Address - Phone:325-226-0513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-13
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty