Healthcare Provider Details

I. General information

NPI: 1689597262
Provider Name (Legal Business Name): ALLISON SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4831 MERLOT AVE UNIT 320
GRAPEVINE TX
76051-7384
US

IV. Provider business mailing address

4000 SIGMA RD APT 9101
DALLAS TX
75244-8135
US

V. Phone/Fax

Practice location:
  • Phone: 817-945-4505
  • Fax: 817-717-8584
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: