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General NPI Number Information
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NPI Number | 1275065641
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Entity Type | Organization
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Legal Business Name | RKO PSYCHOTHERAPY, P.A.
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Dates
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Enumeration Date | 04/03/2017
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Last Update Date | 04/03/2017
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Provider Practice Location Address
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Address Line | 205 E US HIGHWAY 80 SUITE 110
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City | FORNEY
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State | TX
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Zip | 75126-8604
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Country | US
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Telephone | 214-458-0646
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Fax | 972-552-2233
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Provider Business Mailing Address
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Address Line | 205 E US HIGHWAY 80 SUITE 110
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City | FORNEY
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State | TX
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Zip | 75126-8604
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Country | US
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Telephone | 214-458-0646
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Fax | 972-552-2233
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Authorized Official
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Title or Position | SENIOR THERAPIST
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Name | DR. RICKY BRENT OWEN
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Credential | PHD, LMFT
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Telephone | 214-458-0646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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