MEDICARE: DR. GINA N DUNCKEL SMITH PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	38013	TX
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1518374982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GINA N DUNCKEL SMITH PSY.D.

Provider Business Mailing Address
First Line	:	PO BOX 303
Second Line	:
City	:	KEMAH
State	:	TX
Zip	:	77565-0303
Country	:	US
Telephone Number	:	281-910-3913
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 MARINA BAY DR BLDG 113E
Second Line	:
City	:	CLEAR LAKE SHORES
State	:	TX
Zip	:	77565-2263
Country	:	US
Telephone Number	:	281-910-3913
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2014
Last Update Date	:	06/27/2023

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