Healthcare Provider Details

I. General information

NPI: 1780121194
Provider Name (Legal Business Name): JILL CURTIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2017
Last Update Date: 01/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4054 MCKINNEY AVE STE 102
DALLAS TX
75204-2050
US

IV. Provider business mailing address

4054 MCKINNEY AVE STE 102
DALLAS TX
75204-2050
US

V. Phone/Fax

Practice location:
  • Phone: 214-520-6308
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number77008
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: