Healthcare Provider Details

I. General information

NPI: 1629477724
Provider Name (Legal Business Name): KATRINA BELEN PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2014
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1404 GABLES CT STE 102
PLANO TX
75075-7647
US

IV. Provider business mailing address

1404 GABLES CT STE 102
PLANO TX
75075-7647
US

V. Phone/Fax

Practice location:
  • Phone: 214-548-4803
  • Fax: 888-974-0364
Mailing address:
  • Phone: 214-548-4803
  • Fax: 888-974-0364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number34982
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: