Provider Demographics
NPI:1851444905
Name:STEEDE, KEVIN KAVANAUGH (PHD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:KAVANAUGH
Last Name:STEEDE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 MEADOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-6431
Mailing Address - Country:US
Mailing Address - Phone:972-398-0944
Mailing Address - Fax:972-673-0862
Practice Address - Street 1:2820 MEADOWBROOK DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-6431
Practice Address - Country:US
Practice Address - Phone:972-398-0944
Practice Address - Fax:972-673-0862
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3807103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG57YOtherBLUE CROSS BLUE SHIELD