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General NPI Number Information
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NPI Number | 1871092429
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Entity Type | Individual
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Provider Name | STEPHANIE JILL SMITH LPC-S, LCDC
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Gender | Female
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Dates
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Enumeration Date | 02/09/2018
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Last Update Date | 02/09/2018
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Provider Practice Location Address
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Address Line | 4405 PADRE BLVD
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City | SOUTH PADRE ISLAND
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State | TX
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Zip | 78597-7324
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Country | US
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Telephone | 956-367-5687
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 40167
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City | SOUTH PADRE ISLAND
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State | TX
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Zip | 78597-4167
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Country | US
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Telephone |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 11287
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 67438
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 67438
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 67438
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License Number State | TX
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