MEDICARE: MRS. DIRJE ANDREA SMITH MS, NCC, LPC

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	13056	TX

General Provider Information

NPI Number	:	1144475542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DIRJE ANDREA SMITH MS, NCC, LPC

Provider Business Mailing Address
First Line	:	PO BOX 2817
Second Line	:
City	:	ATHENS
State	:	TX
Zip	:	75751-7817
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	506 RICHARDSON ST
Second Line	:
City	:	ATHENS
State	:	TX
Zip	:	75751-3430
Country	:	US
Telephone Number	:	903-677-4800
Fax Number	:

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

Provider Enumeration Date	:	11/26/2008
Last Update Date	:	11/26/2008

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