Healthcare Provider Details

I. General information

NPI: 1467163444
Provider Name (Legal Business Name): KATELIN SUE DIAS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2022
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 E 29TH ST
BRYAN TX
77802-2622
US

IV. Provider business mailing address

6121 COUNTY ROAD 214
ANDERSON TX
77830-8799
US

V. Phone/Fax

Practice location:
  • Phone: 979-774-8200
  • Fax:
Mailing address:
  • Phone: 903-245-0112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number40965
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: