=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730077744
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BOBBIE N SMITH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2025
-----------------------------------------------------
Last Update Date | 06/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17347 VILLAGE GREEN DR STE 104
-----------------------------------------------------
City | JERSEY VILLAGE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77040-1164
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-343-3654
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1010 SPRING CYPRESS RD # 112
-----------------------------------------------------
City | SPRING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77373-2503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-523-0086
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 10503
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------