Provider Demographics
NPI:1841871134
Name:RUNYON, KATIE (PHD)
Entity type:Individual
Prefix:DR
First Name:KATIE
Middle Name:
Last Name:RUNYON
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 1:2608 PINE TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-6856
Mailing Address - Country:US
Mailing Address - Phone:773-822-3709
Mailing Address - Fax:
Practice Address - Street 1:8668 JOHN HICKMAN PKWY STE 804
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-9386
Practice Address - Country:US
Practice Address - Phone:469-604-7077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38107103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist