Healthcare Provider Details

I. General information

NPI: 1871869495
Provider Name (Legal Business Name): JASPER SMITS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 12/08/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2013 PEACH TREE ST
AUSTIN TX
78704-2840
US

IV. Provider business mailing address

2013 PEACH TREE ST
AUSTIN TX
78704-2840
US

V. Phone/Fax

Practice location:
  • Phone: 512-810-0375
  • Fax:
Mailing address:
  • Phone: 512-810-0375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number33238
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: