Provider Demographics
NPI:1447373741
Name:BABICK, KYLE (PHD)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:
Last Name:BABICK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8340 MEADOW RD
Mailing Address - Street 2:SUITE 134
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-3769
Mailing Address - Country:US
Mailing Address - Phone:214-559-5757
Mailing Address - Fax:214-378-7009
Practice Address - Street 1:8340 MEADOW RD
Practice Address - Street 2:SUITE 134
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3769
Practice Address - Country:US
Practice Address - Phone:214-559-5757
Practice Address - Fax:214-378-7009
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23421103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
8F20652OtherMEDICARE INDIVIDUAL PTAN
TXCPS23421TXOtherTEXAS WORKERS COMP PROVID