Provider Demographics
NPI:1700882339
Name:WORTZ, KATHRYN (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:
Last Name:WORTZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11937 US HIGHWAY 271
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75708-3154
Mailing Address - Country:US
Mailing Address - Phone:903-877-7248
Mailing Address - Fax:903-877-7778
Practice Address - Street 1:11937 US HIGHWAY 271
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75708-3154
Practice Address - Country:US
Practice Address - Phone:903-877-7248
Practice Address - Fax:903-877-7778
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23861103TC0700X
HIPSY 703103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXUS22730Medicare UPIN
TX0362709-01Medicaid
TX0U09XOtherBLUE CROSS/BLUE SHIELD PR
TXUS22730Medicare UPIN