MEDICARE: DR. GOSBY KING JR. ED.D.

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	5685	TX
2	101YP2500X	Professional Counselor	6081	TX

General Provider Information

NPI Number	:	1962503490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GOSBY KING JR. ED.D.

Provider Business Mailing Address
First Line	:	3827 S BUCKNER BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75227-4312
Country	:	US
Telephone Number	:	214-489-9300
Fax Number	:	214-489-9301

Provider Business Practice Location Address
First Line	:	3827 S BUCKNER BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75227-4312
Country	:	US
Telephone Number	:	214-489-9300
Fax Number	:	214-489-9301

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

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	09/11/2025

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