Provider Demographics
NPI:1811081961
Name:GONIK, URI L (PHD)
Entity type:Individual
Prefix:DR
First Name:URI
Middle Name:L
Last Name:GONIK
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 1:2003 PATTERSON DR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-5645
Mailing Address - Country:US
Mailing Address - Phone:361-575-5021
Mailing Address - Fax:361-575-0623
Practice Address - Street 1:2003 PATTERSON DR
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5645
Practice Address - Country:US
Practice Address - Phone:361-575-5021
Practice Address - Fax:361-575-0623
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-0099103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4308984OtherAETNA
TX038947001Medicaid
TX81602POtherBLUECROSSBLUESHIELD
TX81602POtherBLUECROSSBLUESHIELD