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General NPI Number Information
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NPI Number | 1396406898
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Entity Type | Organization
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Legal Business Name | BLACKETT & SMITH PLLC
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Dates
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Enumeration Date | 01/06/2022
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Last Update Date | 02/08/2023
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Provider Practice Location Address
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Address Line | 750 N SAINT PAUL ST STE 605
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City | DALLAS
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State | TX
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Zip | 75201-3223
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Country | US
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Telephone | 214-864-1792
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Fax |
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Provider Business Mailing Address
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Address Line | 750 N SAINT PAUL ST STE 605
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City | DALLAS
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State | TX
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Zip | 75201-3223
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Country | US
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Telephone | 214-864-1792
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOHN CARTER
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Credential | LCSW
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Telephone | 214-864-1792
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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