Healthcare Provider Details

I. General information

NPI: 1710566773
Provider Name (Legal Business Name): DALLAS CENTER FOR ADVANCED DEPRESSION TREATMENTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 04/13/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16479 DALLAS PKWY STE 320
ADDISON TX
75001-6709
US

IV. Provider business mailing address

16479 DALLAS PKWY STE 320
ADDISON TX
75001-6709
US

V. Phone/Fax

Practice location:
  • Phone: 469-484-4260
  • Fax:
Mailing address:
  • Phone: 469-484-4260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARTY NEAL BENNETT
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 469-484-4260