Provider Demographics
NPI:1952402471
Name:HACKNEY, GARY R (PHD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:R
Last Name:HACKNEY
Suffix:
Gender:M
Credentials:PHD
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Mailing Address - Street 1:7701 E KELLOGG DR
Mailing Address - Street 2:SUITE 640
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-1706
Mailing Address - Country:US
Mailing Address - Phone:316-683-8668
Mailing Address - Fax:316-683-4587
Practice Address - Street 1:7701 E KELLOGG DR
Practice Address - Street 2:STE 840
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-1706
Practice Address - Country:US
Practice Address - Phone:316-683-8668
Practice Address - Fax:316-683-4587
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2018-11-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS0375103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS04461Medicare ID - Type Unspecified