Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 64761 | TX |
NPI | 1003193988 |
---|---|
Provider Name | Missy M. Smith |
First Address | Lewisville, TX 75057-5151 |
Second Address | Lewisville, TX 75057-5151 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2011 |
Last Update Date | 07/11/2011 |