Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | 1544448 | TX |
Y | 1041C0700X | Clinical Social Worker | 1544448 | TX |
NPI | 1083014534 |
---|---|
Provider Name | Mr. Josh Smith |
First Address | Gladewater, TX 75647-2523 |
Second Address | Gladewater, TX 75647-2523 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2014 |
Last Update Date | 02/09/2014 |