Basic Information
| Provider Information | |||||||||
| NPI: | 1093909590 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VITAL | ||||||||
| FirstName: | DENETTE | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN, M.A., LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 N CENTRAL EXPY | ||||||||
| Address2: | SUITE 400-8 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752014312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4696585457 | ||||||||
| FaxNumber: | 4692274251 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 N CENTRAL EXPY | ||||||||
| Address2: | SUITE 400-8 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752014312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4696585457 | ||||||||
| FaxNumber: | 4692274251 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2007 | ||||||||
| LastUpdateDate: | 08/28/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 60854 | TX | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.