MEDICARE: KATHLEEN K CANTRELL PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC2200X	Clinical Child & Adolescent Psychologist	34509	TX

General Provider Information

NPI Number	:	1528380987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN K CANTRELL PHD

Provider Business Mailing Address
First Line	:	9153 BELSHIRE DR STE 140
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76182-7643
Country	:	US
Telephone Number	:	817-440-4673
Fax Number	:	866-650-6153

Provider Business Practice Location Address
First Line	:	9153 BELSHIRE DR STE 140
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76182-7643
Country	:	US
Telephone Number	:	817-440-4673
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2010
Last Update Date	:	02/19/2026

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