Healthcare Provider Details

I. General information

NPI: 1063920551
Provider Name (Legal Business Name): SUSAN R SMART LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2018
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10807 PERN BETL RD STE 300
SAN ANTONIO TX
78217-3144
US

IV. Provider business mailing address

10807 PERN BETL RD STE 300
SAN ANTONIO TX
78217-3144
US

V. Phone/Fax

Practice location:
  • Phone: 210-245-7862
  • Fax: 210-245-7951
Mailing address:
  • Phone: 210-245-7862
  • Fax: 210-245-7951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number75500
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: