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Individual

KEVIN DOUGLAS STARK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PH.D.

Contact information

Practice address
1600 W 38TH ST STE 212, AUSTIN, TX 78731-6405
(512) 324-3315
(512) 324-3314
Mailing address
1600 W 38TH ST STE 212, AUSTIN, TX 78731-6405
(512) 324-3315
(512) 324-3314

Taxonomy

Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
2-3732
TX
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
2-3732
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
328753401
TX
05
328753402
TX
05
328753403
TX
Enumeration date
11/11/2008
Last updated
12/02/2014
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