Provider Demographics
NPI:1730661943
Name:MCCRARY, KATRINA AGNEAUELLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATRINA
Middle Name:AGNEAUELLE
Last Name:MCCRARY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:KATRINA
Other - Middle Name:AGNEAUELLE
Other - Last Name:GARY-FORTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:6201 BONHOMME RD # 430N
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-4365
Mailing Address - Country:US
Mailing Address - Phone:832-975-0000
Mailing Address - Fax:
Practice Address - Street 1:6201 BONHOMME RD # 430N
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-4365
Practice Address - Country:US
Practice Address - Phone:832-975-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-04
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 3245S0500X
TX12529101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children