Healthcare Provider Details

I. General information

NPI: 1023709474
Provider Name (Legal Business Name): TRIBE THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 N HOUSTON ST APT 508
DALLAS TX
75219-7853
US

IV. Provider business mailing address

539 W COMMERCE ST # 1017
DALLAS TX
75208-1953
US

V. Phone/Fax

Practice location:
  • Phone: 708-275-0596
  • Fax:
Mailing address:
  • Phone: 708-275-0596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: CLAUDIA SMITH
Title or Position: CEO
Credential:
Phone: 708-275-0596