MEDICARE: MRS. EVONNEY SMITH

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	103K00000X	Behavior Analyst	5762	TX
2	106S00000X	Behavior Technician		TX

General Provider Information

NPI Number	:	1225603863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EVONNEY SMITH

Provider Business Mailing Address
First Line	:	4460 S FM 1626 STE 300
Second Line	:
City	:	KYLE
State	:	TX
Zip	:	78640-2976
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4460 S FM 1626 STE 300
Second Line	:
City	:	KYLE
State	:	TX
Zip	:	78640-2976
Country	:	US
Telephone Number	:	737-404-3800
Fax Number	:

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

Provider Enumeration Date	:	05/25/2021
Last Update Date	:	04/05/2023

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Directions to “ MRS. EVONNEY SMITH ” Practice Location

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