Provider Demographics
NPI:1245211036
Name:KIGHT, MARY (PHD, CRC)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:KIGHT
Suffix:
Gender:F
Credentials:PHD, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12225 GREENVILLE AVE
Mailing Address - Street 2:STE 700
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243
Mailing Address - Country:US
Mailing Address - Phone:214-477-5587
Mailing Address - Fax:214-242-2043
Practice Address - Street 1:12225 GREENVILLE AVE
Practice Address - Street 2:STE 700
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-9362
Practice Address - Country:US
Practice Address - Phone:214-477-5587
Practice Address - Fax:214-242-2043
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30564103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00509EMedicare ID - Type Unspecified