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General NPI Number Information
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NPI Number | 1154738516
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Entity Type | Individual
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Provider Name | GABRIEL JASSO PH.D
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Gender | Male
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Dates
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Enumeration Date | 07/17/2014
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Last Update Date | 04/13/2015
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Provider Practice Location Address
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Address Line | 12800 PRESTON RD SUITE 101
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City | DALLAS
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State | TX
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Zip | 75230-1365
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Country | US
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Telephone | 972-789-9600
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Fax | 972-789-9607
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Provider Business Mailing Address
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Address Line | 12800 PRESTON RD SUITE 101
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City | DALLAS
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State | TX
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Zip | 75230-1365
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Country | US
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Telephone | 972-789-9600
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Fax | 972-789-9607
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 36112
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License Number State | TX
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