Provider Demographics
NPI:1659794196
Name:DE JESUS, KERRY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KERRY
Middle Name:
Last Name:DE JESUS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 THOMPSON DR
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-5154
Mailing Address - Country:US
Mailing Address - Phone:830-896-2211
Mailing Address - Fax:
Practice Address - Street 1:721 THOMPSON DR
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-5154
Practice Address - Country:US
Practice Address - Phone:830-896-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-03
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30678103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical