Provider Demographics
NPI:1033133376
Name:SEALE, KATHRINE ANNE (PSYD, PA)
Entity type:Individual
Prefix:DR
First Name:KATHRINE
Middle Name:ANNE
Last Name:SEALE
Suffix:
Gender:F
Credentials:PSYD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 806
Mailing Address - Street 2:
Mailing Address - City:COMFORT
Mailing Address - State:TX
Mailing Address - Zip Code:78013-0806
Mailing Address - Country:US
Mailing Address - Phone:830-257-2777
Mailing Address - Fax:830-995-2565
Practice Address - Street 1:2404 MEMORIAL BLVD STE C-08
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-5630
Practice Address - Country:US
Practice Address - Phone:830-257-2777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX025622103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0029CTOtherBLUE CROSS BLUE SHIELD
TX44602OtherNATIONAL REGISTER OF HEAL
TX0029CTOtherBLUE CROSS BLUE SHIELD
TX00137EMedicare ID - Type UnspecifiedMEDICARE