Provider Demographics
NPI:1487157350
Name:JETER, DAVID PAUL SR (LCDC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:PAUL
Last Name:JETER
Suffix:SR
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:PAUL
Other - Last Name:JETER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:JETER AND ASSOCIATES
Mailing Address - Street 1:4506 BRADSHAW ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75215-4429
Mailing Address - Country:US
Mailing Address - Phone:214-280-4496
Mailing Address - Fax:
Practice Address - Street 1:4506 BRADSHAW ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75215-4429
Practice Address - Country:US
Practice Address - Phone:214-280-4496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-16
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5700101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)