Provider Demographics
NPI:1437304300
Name:TOM, KERRI L (PSYD)
Entity type:Individual
Prefix:DR
First Name:KERRI
Middle Name:L
Last Name:TOM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 S IH 35
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-9426
Mailing Address - Country:US
Mailing Address - Phone:254-939-2100
Mailing Address - Fax:254-939-2334
Practice Address - Street 1:3500 S IH 35
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-9426
Practice Address - Country:US
Practice Address - Phone:254-939-2100
Practice Address - Fax:254-939-2334
Is Sole Proprietor?:No
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33955103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical