Provider Demographics
NPI:1366848889
Name:ROBERTS, JETT CUTTER (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:JETT
Middle Name:CUTTER
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9600 GOLF LAKES TRL APT 1010
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-5012
Mailing Address - Country:US
Mailing Address - Phone:325-721-9633
Mailing Address - Fax:
Practice Address - Street 1:12800 PRESTON RD STE 101
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1366
Practice Address - Country:US
Practice Address - Phone:972-789-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-11
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70446101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional