Provider Demographics
NPI:1356903611
Name:CHADWICK, KATIE (PHD)
Entity type:Individual
Prefix:DR
First Name:KATIE
Middle Name:
Last Name:CHADWICK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:MCKELVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:15935 KNOLL TRAIL DR APT 2201
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-2780
Mailing Address - Country:US
Mailing Address - Phone:432-528-6397
Mailing Address - Fax:
Practice Address - Street 1:1412 MAIN ST STE 320
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75202-4701
Practice Address - Country:US
Practice Address - Phone:214-760-1964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-07
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38188103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling