Provider Demographics
NPI:1285716001
Name:KANTRA, DAVID S (PSYD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:S
Last Name:KANTRA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-1569
Mailing Address - Country:US
Mailing Address - Phone:251-928-5353
Mailing Address - Fax:251-990-4962
Practice Address - Street 1:150 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-1569
Practice Address - Country:US
Practice Address - Phone:251-928-5353
Practice Address - Fax:251-990-4962
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL768103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALR55151Medicare UPIN