Provider Demographics
NPI:1609128123
Name:HART, KATRENA (MS, LPC-S, CBT, ATA,)
Entity type:Individual
Prefix:
First Name:KATRENA
Middle Name:
Last Name:HART
Suffix:
Gender:F
Credentials:MS, LPC-S, CBT, ATA,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 S ALMA DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-3771
Mailing Address - Country:US
Mailing Address - Phone:972-562-5002
Mailing Address - Fax:
Practice Address - Street 1:203 S ALMA DR
Practice Address - Street 2:SUITE 200
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-3771
Practice Address - Country:US
Practice Address - Phone:972-562-5002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15619101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health