Provider Demographics
NPI:1972841542
Name:MCKENZIE-MEREDITH, KATHERINE R (PSYD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:R
Last Name:MCKENZIE-MEREDITH
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 1:411 N WASHINGTON AVE
Mailing Address - Street 2:SUITE 5000
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1713
Mailing Address - Country:US
Mailing Address - Phone:214-818-2536
Mailing Address - Fax:214-818-8466
Practice Address - Street 1:411 N WASHINGTON AVE
Practice Address - Street 2:SUITE 5000
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1713
Practice Address - Country:US
Practice Address - Phone:214-818-2536
Practice Address - Fax:214-818-8466
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36175103G00000X, 103T00000X, 103TC0700X, 103TH0004X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation