Healthcare Provider Details

I. General information

NPI: 1215201876
Provider Name (Legal Business Name): DALLAS CBT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2012
Last Update Date: 02/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7557 RAMBLER RD SUITE 1100
DALLAS TX
75231-4142
US

IV. Provider business mailing address

5904 JUNIUS ST
DALLAS TX
75214-4428
US

V. Phone/Fax

Practice location:
  • Phone: 214-476-6176
  • Fax:
Mailing address:
  • Phone: 214-768-4125
  • 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: DR. JASPER SMITS
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 214-768-4125