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General NPI Number Information
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NPI Number | 1407360860
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Entity Type | Organization
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Legal Business Name | STARBROOK THERAPY CENTER, INC.
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Dates
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Enumeration Date | 11/21/2017
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Last Update Date | 11/21/2017
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Provider Practice Location Address
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Address Line | 4221 MEDICAL PKWY STE 400
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City | CARROLLTON
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State | TX
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Zip | 75010-4548
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Country | US
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Telephone | 469-608-1352
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Fax |
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Provider Business Mailing Address
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Address Line | 4221 MEDICAL PKWY STE 400
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City | CARROLLTON
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State | TX
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Zip | 75010-4548
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. KATIE CANTERO
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Credential | PSYD
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Telephone | 469-608-1352
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 37416
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License Number State | TX
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