MEDICARE: DELANE RAYE KINNEY PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist	21935	TX

General Provider Information

NPI Number	:	1366489726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DELANE RAYE KINNEY PHD

Provider Business Mailing Address
First Line	:	106 E 10TH ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75203-2236
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2606 STATE ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75204-2600
Country	:	US
Telephone Number	:	214-915-4784
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	07/08/2007

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