Individual
SALETHA BRENETHA SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1300 W LANCASTER AVE STE 205, FORT WORTH, TX 76102-3490
(817) 336-8611
Mailing address
PO BOX 733784, DALLAS, TX 75373-3784
(817) 336-8611
Taxonomy
Speciality
Code
Description
License number
State
2080P0006X
Developmental - Behavioral Pediatrics Physician
Primary
S8122
TX
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
12/03/2009
Last updated
10/26/2020
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