Basic Information
| Provider Information | |||||||||
| NPI: | 1962503490 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KING | ||||||||
| FirstName: | GOSBY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | ED.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3827 S BUCKNER BLVD | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752274312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2144899300 | ||||||||
| FaxNumber: | 2144899301 | ||||||||
| Practice Location | |||||||||
| Address1: | 3827 S BUCKNER BLVD | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752274312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2144899300 | ||||||||
| FaxNumber: | 2144899301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 5685 | TX | X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP2500X | 6081 | TX | X | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.