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General NPI Number Information
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NPI Number | 1093332199
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Entity Type | Individual
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Provider Name | REBECCA SMITH LPC
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Gender | Female
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Dates
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Enumeration Date | 07/06/2020
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Last Update Date | 07/06/2020
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Provider Practice Location Address
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Address Line | 11803 CLASSIC LN
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City | FORNEY
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State | TX
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Zip | 75126-7077
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Country | US
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Telephone | 972-552-5559
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Fax |
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Provider Business Mailing Address
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Address Line | 2648 BIG SPRING DR
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City | FORT WORTH
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State | TX
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Zip | 76120-5622
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Country | US
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Telephone | 936-714-7980
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 75060
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License Number State | TX
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