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General NPI Number Information
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NPI Number | 1215966866
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Entity Type | Individual
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Provider Name | KATHY DEORNELLAS PHD
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Gender | Female
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 08/11/2010
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Provider Practice Location Address
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Address Line | 927 N LOCUST ST
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City | DENTON
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State | TX
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Zip | 76201-2953
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Country | US
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Telephone | 940-230-6486
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Fax | 940-535-1405
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Provider Business Mailing Address
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Address Line | PO BOX 161
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City | DENTON
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State | TX
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Zip | 76202-0161
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Country | US
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Telephone | 940-230-6486
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Fax | 940-536-1406
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 31293
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License Number State | TX
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