Healthcare Provider Details

I. General information

NPI: 1477298198
Provider Name (Legal Business Name): MR. PRESTON SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2022
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 HILLRISE CIR
LAS CRUCES NM
88011-4741
US

IV. Provider business mailing address

4988 LOCUST RD
GILMER TX
75645-2911
US

V. Phone/Fax

Practice location:
  • Phone: 575-288-1881
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number7377
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: