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General NPI Number Information
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NPI Number | 1447544812
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Entity Type | Organization
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Legal Business Name | BERNARD J. GOTWAY, PH.D., P.C.
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Dates
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Enumeration Date | 06/02/2011
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Last Update Date | 06/02/2011
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Provider Practice Location Address
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Address Line | 1701 GATEWAY BLVD STE 447
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City | RICHARDSON
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State | TX
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Zip | 75080-3572
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Country | US
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Telephone | 972-918-9333
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Fax | 972-783-8444
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Provider Business Mailing Address
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Address Line | 1701 GATEWAY BLVD STE 447
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City | RICHARDSON
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State | TX
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Zip | 75080-3572
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Country | US
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Telephone | 972-918-9333
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Fax | 972-783-8444
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Authorized Official
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Title or Position | PRESIDENT / OWNER
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Name | DR. BERNARD J. GOTWAY
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Credential | PH.D.
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Telephone | 972-918-9333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 22116
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License Number State | TX
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