Healthcare Provider Details

I. General information

NPI: 1265707103
Provider Name (Legal Business Name): BETSY REDD SMITH M.A. L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2012
Last Update Date: 03/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 FM 1669
HUNTINGTON TX
75949-2918
US

IV. Provider business mailing address

PO BOX 1175
HUNTINGTON TX
75949-1175
US

V. Phone/Fax

Practice location:
  • Phone: 936-854-2857
  • Fax:
Mailing address:
  • Phone: 936-854-2857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number15960
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: