Provider Demographics
NPI:1124457346
Name:EUBANK, KENNETH EUGENE JR
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:EUGENE
Last Name:EUBANK
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001W. PLANO PARKWAY
Mailing Address - Street 2:SUITE 2300
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075
Mailing Address - Country:US
Mailing Address - Phone:972-422-8383
Mailing Address - Fax:972-422-2711
Practice Address - Street 1:2001 W PLANO PKWY
Practice Address - Street 2:SUITE 2300
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-8601
Practice Address - Country:US
Practice Address - Phone:972-422-8383
Practice Address - Fax:972-422-2711
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64936101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional