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General NPI Number Information
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NPI Number | 1033375142
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Entity Type | Organization
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Legal Business Name | SMYTH COUNSELING
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Dates
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Enumeration Date | 07/29/2008
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Last Update Date | 07/29/2008
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Provider Practice Location Address
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Address Line | 6220 GASTON AVE STE 501
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City | DALLAS
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State | TX
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Zip | 75214-4354
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Country | US
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Telephone | 469-371-5886
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Fax | 214-824-3860
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Provider Business Mailing Address
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Address Line | 517 CLERMONT ST
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City | DALLAS
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State | TX
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Zip | 75223-1207
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Country | US
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Telephone | 469-371-5886
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Fax | 214-824-3860
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Authorized Official
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Title or Position | REGISTERED AGENT
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Name | MR. JACK SMYTH
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Credential |
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Telephone | 214-319-9447
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC 13621
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License Number State | TX
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