Healthcare Provider Details

I. General information

NPI: 1942982301
Provider Name (Legal Business Name): MRS. SHANTERIA ANNTIONETTE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2023
Last Update Date: 08/04/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4507 HARDWOOD GLEN DR
FRESNO TX
77545-9593
US

IV. Provider business mailing address

4507 HARDWOOD GLEN DR
FRESNO TX
77545-9593
US

V. Phone/Fax

Practice location:
  • Phone: 979-943-0026
  • Fax:
Mailing address:
  • Phone: 281-780-0240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: