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General NPI Number Information
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NPI Number | 1851642003
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Entity Type | Individual
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Provider Name | NICHOLAS JOHN KATKO PH.D.
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Gender | Male
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Dates
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Enumeration Date | 09/27/2012
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Last Update Date | 04/01/2021
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Provider Practice Location Address
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Address Line | 2484 GARDEN AVE BLDG 3820
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City | FORT SAM HOUSTON
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State | TX
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Zip | 78234-7802
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Country | US
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Telephone | 210-539-1069
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Fax |
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Provider Business Mailing Address
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Address Line | 2484 GARDEN AVE BLDG 3820
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City | FORT SAM HOUSTON
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State | TX
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Zip | 78234-7802
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Country | US
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Telephone | 210-539-1069
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Fax |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 36166
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License Number State | TX
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