Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 37628 | TX |
Y | 103T00000X | Psychologist | 37628 | TX |
N | 102L00000X | Psychologist | PSY.0004166 | CO |
N | 103T00000X | Psychologist | PSY.0004166 | CO |
N | 103TS0200X | School Psychologist | 101523 | CO |
N | 103TS0200X | School Psychologist | 71112 | TX |
NPI | 1043697774 |
---|---|
Provider Name | Dr. Kate Stark |
First Address | Keller, TX 76248 |
Second Address | Keller, TX 76248 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2015 |
Last Update Date | 07/06/2019 |