MEDICARE: DR. BERNADETTE PEARLINE SMITH EDD., LPC-S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	67671	TX

General Provider Information

NPI Number	:	1063857431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BERNADETTE PEARLINE SMITH EDD., LPC-S

Provider Business Mailing Address
First Line	:	11601 SHADOW CREEK PKWY STE 111-659
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-7283
Country	:	US
Telephone Number	:	713-581-4527
Fax Number	:

Provider Business Practice Location Address
First Line	:	11601 SHADOW CREEK PKWY STE 111-659
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-7283
Country	:	US
Telephone Number	:	713-581-4527
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/30/2013
Last Update Date	:	04/14/2021

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