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General NPI Number Information
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NPI Number | 1578801916
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Entity Type | Individual
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Provider Name | RYAN RANDALL SMITH PHD, LMFT-S, LPC-S
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Gender | Male
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Dates
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Enumeration Date | 01/18/2013
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Last Update Date | 04/29/2024
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Provider Practice Location Address
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Address Line | 844 OLD MILLWOOD RD
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City | ROCKWALL
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State | TX
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Zip | 75087-8368
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Country | US
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Telephone | 972-653-2919
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Fax |
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Provider Business Mailing Address
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Address Line | 844 OLD MILLWOOD RD
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City | ROCKWALL
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State | TX
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Zip | 75087-8368
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Country | US
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Telephone | 972-653-2919
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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 | 69270
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 201943
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License Number State | TX
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