Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 35086 | TX |
Y | 103T00000X | Psychologist | 35086 | TX |
N | 102L00000X | Psychologist | PSY19357 | CA |
N | 103T00000X | Psychologist | PSY19357 | CA |
N | 103TH0100X | Health Service | PSY19357 | CA |
NPI | 1467583419 |
---|---|
Provider Name | Kathy Marie Van Stone |
First Address | Temple, TX 76504-6803 |
Second Address | Austin, TX 78731-3783 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2007 |
Last Update Date | 09/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q06382 | (02) | CA |