1578602223 NPI number — MR. ROB F SMITH LCSW

Table of content: MR. ROB F SMITH LCSW (NPI 1578602223)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578602223 NPI number — MR. ROB F SMITH LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
ROB
Provider Middle Name:
F
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SMITH
Provider Other First Name:
ROBERT
Provider Other Middle Name:
F
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1578602223
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6429 SUNNYLAND LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75214-3188
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-543-5449
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8035 EAST R L THORNTON FREEWAY
Provider Second Line Business Practice Location Address:
SUITE #503
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-319-9200
Provider Business Practice Location Address Fax Number:
214-319-9209
Provider Enumeration Date:
02/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  07705 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 101204901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10009262 . This is a "CHIP AMERIGROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 62308 . This is a "CIGNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 128628 . This is a "NORTHSTAR VALUE OPTIONS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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