Provider Demographics
NPI:1962136309
Name:SMITH, ALEX JOSEPH (BEHAVIOR COACH)
Entity type:Individual
Prefix:MR
First Name:ALEX
Middle Name:JOSEPH
Last Name:SMITH
Suffix:
Gender:M
Credentials:BEHAVIOR COACH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6030 MILTON ST APT 3134
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-4477
Mailing Address - Country:US
Mailing Address - Phone:970-729-2231
Mailing Address - Fax:
Practice Address - Street 1:13140 COIT RD STE 518
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-5725
Practice Address - Country:US
Practice Address - Phone:817-677-8353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst