MEDICARE: MR. JETT CUTTER ROBERTS M.A., LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	70446	TX

General Provider Information

NPI Number	:	1366848889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JETT CUTTER ROBERTS M.A., LPC

Provider Business Mailing Address
First Line	:	9600 GOLF LAKES TRL APT 1010
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-5012
Country	:	US
Telephone Number	:	325-721-9633
Fax Number	:

Provider Business Practice Location Address
First Line	:	12800 PRESTON RD STE 101
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-1366
Country	:	US
Telephone Number	:	972-789-9600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/11/2014
Last Update Date	:	11/11/2014

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