Provider Demographics
NPI:1740233295
Name:BIG SKY COUNSELING AND ASSESSMENT
Entity Type:Organization
Organization Name:BIG SKY COUNSELING AND ASSESSMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOWNACKI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:940-631-6585
Mailing Address - Street 1:2910 KEMP BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-1070
Mailing Address - Country:US
Mailing Address - Phone:940-631-6585
Mailing Address - Fax:940-696-0837
Practice Address - Street 1:2910 KEMP BLVD
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-1070
Practice Address - Country:US
Practice Address - Phone:940-631-6585
Practice Address - Fax:940-696-0837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30876103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00693EMedicare ID - Type UnspecifiedPSYCHOLOGIST