Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 31579 | TX |
NPI | 1174552426 |
---|---|
Provider Name | Dr. Bret Bentz |
First Address | Fort Worth, TX 76179-9286 |
Second Address | Fort Worth, TX 76179-9286 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 07/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0015MJ | BLUE CROSS (01) | TX |
159445901 | (05) | TX |