Provider Demographics
NPI:1003855024
Name:VEITH, DALE J (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:J
Last Name:VEITH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 S W S YOUNG DR STE 407
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-3374
Mailing Address - Country:US
Mailing Address - Phone:254-252-3748
Mailing Address - Fax:254-549-0086
Practice Address - Street 1:3800 S W S YOUNG DR STE 407
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-3374
Practice Address - Country:US
Practice Address - Phone:254-252-3747
Practice Address - Fax:254-549-0086
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1292103TC0700X, 103TR0400X
TX38739103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR292464Medicaid
OR292464Medicaid