MEDICARE: ANNE SMITH INC

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	31815	TX

General Provider Information

NPI Number	:	1790920056
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANNE SMITH INC

Provider Business Mailing Address
First Line	:	3737 COLE AVE
Second Line	:	#110
City	:	DALLAS
State	:	TX
Zip	:	75204-1591
Country	:	US
Telephone Number	:	214-789-7279
Fax Number	:

Provider Business Practice Location Address
First Line	:	6910 ROCKVIEW LANE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75214
Country	:	US
Telephone Number	:	214-789-7279
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	ANNE SMITH
Credential	:	PH.D.
Telephone Number	:	214-789-7279

Provider Enumeration Date	:	12/15/2008
Last Update Date	:	12/15/2008

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