Individual
ROBERT WAYNE MCKENZIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
933 W CONNALLY ST, TYLER, TX 75701-1404
(903) 581-5714
(903) 534-1507
Mailing address
933 W CONNALLY ST, P.O. BOX 0297, TYLER, TX 75701-1404
(903) 752-1004
(903) 683-3212
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
25161
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100340204
—
TX
01
—
P00254134
RAIL ROAD MEDICARE
TX
Enumeration date
03/28/2007
Last updated
06/02/2008
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