Healthcare Provider Details

I. General information

NPI: 1659767101
Provider Name (Legal Business Name): CHRISTINA G SMITH B.S., M.A, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRISTINA G SANNER

II. Dates (important events)

Enumeration Date: 04/11/2015
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6105 DENTON HWY STE 80
HALTOM CITY TX
76148-3021
US

IV. Provider business mailing address

6105 DENTON HWY STE 80
HALTOM CITY TX
76148-3021
US

V. Phone/Fax

Practice location:
  • Phone: 817-654-5790
  • Fax: 817-221-0588
Mailing address:
  • Phone: 817-654-5790
  • Fax: 817-221-0588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number63048
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number63048
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number63048
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number63048
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number63048
License Number StateTX
# 6
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number63048
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: