Provider Demographics
NPI:1356699847
Name:CANTERO, KATIE JEANNE (PSYD)
Entity type:Individual
Prefix:DR
First Name:KATIE
Middle Name:JEANNE
Last Name:CANTERO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MISS
Other - First Name:KATIE
Other - Middle Name:JEANNE
Other - Last Name:WAID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:2441 MEDICAL PARKWAY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010
Mailing Address - Country:US
Mailing Address - Phone:469-608-1352
Mailing Address - Fax:469-283-2953
Practice Address - Street 1:2441 MEDICAL PARKWAY
Practice Address - Street 2:SUITE 400
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010
Practice Address - Country:US
Practice Address - Phone:469-608-1352
Practice Address - Fax:469-283-2953
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00P96MOtherBLUECROSS BLUESHIELD OF TEXAS INDIVIDUAL RECORD ID