Individual provider Active NPI

Bernard J. Gotway, PH.D.

  • Psychologist
  • Richardson, TX
National Provider Identifier
1396721700
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
TX2-2116HSP Issued in TX
Practice address
1701 Gateway Blvd
Suite 447
Richardson, TX 75080-3572
Phone
(972) 918-9333
Fax
(972) 783-8444
NPI assigned
Dec 16, 2005
Last updated
Jul 13, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X TX2-2116HSP TX Primary

Addresses

Primary practice location

1701 Gateway Blvd
Suite 447
Richardson, TX 75080-3572

Mailing address

1701 Gateway Blvd
Suite 447
Richardson, TX 75080-3572
Phone (972) 918-9333

Other identifiers 1

IdentifierTypeStateIssuer
00BY87OtherTXBLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
TX2-2116HSPTXMDPsychologist
22116TXMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Citizens Healthcare Services LLC PastSince Aug 2, 2020 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1134691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1396721700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 GATEWAY BLVD",
            "address_2": "SUITE 447",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750803572",
            "telephone_number": "972-918-9333",
            "fax_number": "972-783-8444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 GATEWAY BLVD",
            "address_2": "SUITE 447",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750803572",
            "telephone_number": "972-918-9333",
            "fax_number": "972-783-8444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOTWAY",
        "first_name": "BERNARD",
        "middle_name": "J.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-16",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "TX",
            "license": "TX2-2116HSP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "00BY87",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Richardson, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.