Healthcare Provider Details

I. General information

NPI: 1831142256
Provider Name (Legal Business Name): SHILAIN SMITH PH.D LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHILAIN THOMAS

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 01/03/2024
Certification Date: 03/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 MEDICAL DR STE 330
SAN ANTONIO TX
78229-5805
US

IV. Provider business mailing address

20702 WILD SPRINGS DR
SAN ANTONIO TX
78258-7411
US

V. Phone/Fax

Practice location:
  • Phone: 210-614-4990
  • Fax: 210-614-4991
Mailing address:
  • Phone: 404-641-7750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5299
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5167
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6485
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number79127
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: