Provider Demographics
NPI:1992199384
Name:CAMPINHA-BACOTE, DARIUS DEXTER (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DARIUS
Middle Name:DEXTER
Last Name:CAMPINHA-BACOTE
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 1:5601 BRIDGE ST
Mailing Address - Street 2:STE 300
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76112-2355
Mailing Address - Country:US
Mailing Address - Phone:214-945-4295
Mailing Address - Fax:817-492-7001
Practice Address - Street 1:5601 BRIDGE ST
Practice Address - Street 2:STE 300
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112-2384
Practice Address - Country:US
Practice Address - Phone:214-945-4295
Practice Address - Fax:817-492-7001
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-24
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36915103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist