Healthcare Provider Details

I. General information

NPI: 1730503186
Provider Name (Legal Business Name): CAROLYN SMITH LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2014
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1214 N POST OAK RD STE 100
HOUSTON TX
77055-7236
US

IV. Provider business mailing address

PO BOX 264
FRESNO TX
77545
US

V. Phone/Fax

Practice location:
  • Phone: 713-686-9194
  • Fax: 713-686-9413
Mailing address:
  • Phone: 281-757-2871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number68290
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number68290
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: