Healthcare Provider Details

I. General information

NPI: 1477628287
Provider Name (Legal Business Name): KATHLEEN FAHRNER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 09/20/2025
Certification Date: 09/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 W STASSNEY LN
AUSTIN TX
78745-3401
US

IV. Provider business mailing address

2804 ROBIN RD
MANCHACA TX
78652-4175
US

V. Phone/Fax

Practice location:
  • Phone: 512-956-6463
  • Fax:
Mailing address:
  • Phone: 415-515-8168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY14141
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY1148
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number38562
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: