MEDICARE: DR. JENNIFER BETH UNTERBERG PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	32563	TX

General Provider Information

NPI Number	:	1679632798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER BETH UNTERBERG PH.D.

Provider Business Mailing Address
First Line	:	3131 TURTLE CREEK BLVD
Second Line	:	SUITE 1026
City	:	DALLAS
State	:	TX
Zip	:	75219-5405
Country	:	US
Telephone Number	:	214-770-5030
Fax Number	:	214-522-0946

Provider Business Practice Location Address
First Line	:	3131 TURTLE CREEK BLVD
Second Line	:	SUITE 1026
City	:	DALLAS
State	:	TX
Zip	:	75219-5405
Country	:	US
Telephone Number	:	214-770-5030
Fax Number	:	214-522-0946

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	07/21/2009

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