MEDICARE: DR. KATHERINE RIAL MRC, PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	78460	TX
2	103TC0700X	Clinical Psychologist	39570	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	78460	OTHER	TX	TEXAS BEHAVIORAL EXECUTIVE COUNCIL
2	39570	OTHER	TX	TEXAS BEHAVIORAL HEALTH EXECUTIVE COUNCIL

General Provider Information

NPI Number	:	1164135257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHERINE RIAL MRC, PH.D.

Provider Business Mailing Address
First Line	:	5451 MELROSE AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-7147
Country	:	US
Telephone Number	:	214-908-9343
Fax Number	:

Provider Business Practice Location Address
First Line	:	8122 SPRING CYPRESS RD
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-3123
Country	:	US
Telephone Number	:	281-210-6677
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2023
Last Update Date	:	01/04/2023

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