Provider Demographics
NPI:1326109356
Name:O'KRENT, KENNETH IVAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:IVAN
Last Name:O'KRENT
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 1:6210 CAMPBELL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-1379
Mailing Address - Country:US
Mailing Address - Phone:972-250-1705
Mailing Address - Fax:972-250-1710
Practice Address - Street 1:6210 CAMPBELL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-1379
Practice Address - Country:US
Practice Address - Phone:972-250-1705
Practice Address - Fax:972-250-1710
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-3276103TC0700X, 103TF0000X, 103T00000X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00G41CMedicare ID - Type Unspecified