Healthcare Provider Details

I. General information

NPI: 1548088651
Provider Name (Legal Business Name): WENDY HENRICHSON SMARTT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2024
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10127 MOROCCO ST STE 202
SAN ANTONIO TX
78216-3938
US

IV. Provider business mailing address

10127 MOROCCO ST STE 202
SAN ANTONIO TX
78216-3938
US

V. Phone/Fax

Practice location:
  • Phone: 210-326-7191
  • Fax:
Mailing address:
  • Phone: 210-838-5351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number31690
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number30540
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: