Provider Demographics
NPI:1710566773
Name:DALLAS CENTER FOR ADVANCED DEPRESSION TREATMENTS
Entity Type:Organization
Organization Name:DALLAS CENTER FOR ADVANCED DEPRESSION TREATMENTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARTY
Authorized Official - Middle Name:NEAL
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-484-4260
Mailing Address - Street 1:16479 DALLAS PKWY STE 320
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-6709
Mailing Address - Country:US
Mailing Address - Phone:469-484-4260
Mailing Address - Fax:
Practice Address - Street 1:16479 DALLAS PKWY STE 320
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-6709
Practice Address - Country:US
Practice Address - Phone:469-484-4260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRESTON HOLLOW PSYCHIATRY GROUP, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-06
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health