Organization
PF DOVER COUNSELING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT SMITH (OWNER)
(309) 363-2544
Entity
Organization
Contact information
Practice address
515 W SOUTHLAKE BLVD, SUITE NUMBER 172, SOUTHLAKE, TX 76092-6172
(309) 363-2544
Mailing address
515 W SOUTHLAKE BLVD, STE 172, SOUTHLAKE, TX 76092-6172
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
69365
TX
Other
Enumeration date
10/17/2012
Last updated
10/17/2012
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