Stark, Kevin Douglas

Stark, Kevin Douglas is an sole proprietor health care provider with primary practice located at 1600 W 38Th St Ste 212 , Austin TX 78731-6405. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Cognitive & Behavioral, Behavioral Health & Social Service Providers / Clinical Child & Adolescent. Behavioral Health & Social Service Providers / Clinical Child & Adolescent is his primary health care specialty. Stark, Kevin Douglas can be contacted via phone (512) 324-3315.

Contact Information

Primary practice address
1600 W 38Th St Ste 212 Austin TX 78731-6405
Phone: (512) 324-3315
Fax: (512) 324-3314
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Cognitive & Behavioral 103TB0200X 2-3732 Texas
Behavioral Health & Social Service Providers / Clinical Child & Adolescent 103TC2200X 2-3732 Texas

Profile Details

NPI number 1447404918
LBN Legal business name Stark, Kevin Douglas
Credentials PH.D.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 11th, 2008
Last updated Dec 2nd, 2014 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1447404918 NPPES
Texas MEDICAID 328753402
Texas MEDICAID 328753403
Texas MEDICAID 328753401

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