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NPI Code Detail

MEDICARE: DR. KATHRYN WORTZ PHD

MEDICARE: DR. KATHRYN WORTZ PHD
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
1103TC0700XClinical Psychologist23861TX
2103TC0700XClinical PsychologistPSY 703HI

General Provider Information

NPI Number : 1700882339
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KATHRYN WORTZ PHD
Provider Business Mailing Address
First Line : 11937 US HIGHWAY 271
Second Line :
City : TYLER
State : TX
Zip : 75708-3154
Country : US
Telephone Number : 903-877-7248
Fax Number : 903-877-7778
Provider Business Practice Location Address
First Line : 11937 US HIGHWAY 271
Second Line :
City : TYLER
State : TX
Zip : 75708-3154
Country : US
Telephone Number : 903-877-7248
Fax Number : 903-877-7778
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2005
Last Update Date : 09/19/2016

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