Provider Demographics
NPI:1427754241
Name:K.P. EZICHI
Entity type:Organization
Organization Name:K.P. EZICHI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF
Authorized Official - Prefix:
Authorized Official - First Name:K.P.
Authorized Official - Middle Name:
Authorized Official - Last Name:EZICHI
Authorized Official - Suffix:
Authorized Official - Credentials:PSY,MD
Authorized Official - Phone:817-290-4225
Mailing Address - Street 1:14665 PRESTON RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-7880
Mailing Address - Country:US
Mailing Address - Phone:817-290-4225
Mailing Address - Fax:
Practice Address - Street 1:14665 PRESTON RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-7880
Practice Address - Country:US
Practice Address - Phone:817-290-4225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty