Provider Demographics
NPI:1295310001
Name:PEACE PSYCHOLOGY CENTER PLLC
Entity type:Organization
Organization Name:PEACE PSYCHOLOGY CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER AND LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATE
Authorized Official - Middle Name:
Authorized Official - Last Name:STARK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:817-917-7348
Mailing Address - Street 1:1723 E SOUTHLAKE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6445
Mailing Address - Country:US
Mailing Address - Phone:682-292-7012
Mailing Address - Fax:
Practice Address - Street 1:1723 E SOUTHLAKE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6445
Practice Address - Country:US
Practice Address - Phone:817-917-7348
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-12
Last Update Date:2022-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Multi-Specialty
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Multi-Specialty
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty