Healthcare Provider Details

I. General information

NPI: 1821138603
Provider Name (Legal Business Name): RICHARD KOWNACKI PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 08/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 KEMP BLVD SUITE 210
WICHITA FALLS TX
76308-1070
US

IV. Provider business mailing address

2910 KEMP BLVD SUITE 210
WICHITA FALLS TX
76308-1070
US

V. Phone/Fax

Practice location:
  • Phone: 940-631-6585
  • Fax: 940-696-0837
Mailing address:
  • Phone: 940-631-6585
  • Fax: 940-696-0837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number30876
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: