Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 2-3276 | TX |
N | 103T00000X | Psychologist | 2-3276 | TX |
Y | 103G00000X | Clinical Psychologist | 2-3276 | TX |
Y | 103TC0700X | Clinical Psychologist | 2-3276 | TX |
N | 103TF0000X | Family Psychologist | 2-3276 | TX |
N | 103TR0400X | Rehabilitation Psychologist | 2-3276 | TX |
NPI | 1326109356 |
---|---|
Provider Name | Dr. Kenneth Ivan O'krent |
First Address | Dallas, TX 75248-1379 |
Second Address | Dallas, TX 75248-1379 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 13/12/2007 |