Provider Demographics
NPI:1215254008
Name:PRESNELL, KATHERINE ELIZABETH (PHD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ELIZABETH
Last Name:PRESNELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11211 TAYLOR DRAPER LANE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-3971
Mailing Address - Country:US
Mailing Address - Phone:512-343-8850
Mailing Address - Fax:512-343-8079
Practice Address - Street 1:11211 TAYLOR DRAPER LANE
Practice Address - Street 2:SUITE 202
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-3971
Practice Address - Country:US
Practice Address - Phone:512-343-8850
Practice Address - Fax:512-343-8079
Is Sole Proprietor?:No
Enumeration Date:2010-05-03
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33948103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB109219Medicare PIN