MEDICARE: JESSICA SMART

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	101YS0200X	School Counselor
2	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1447999255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA SMART

Provider Business Mailing Address
First Line	:	150 WILHEM WAY
Second Line	:
City	:	UHLAND
State	:	TX
Zip	:	78640-2498
Country	:	US
Telephone Number	:	210-860-0440
Fax Number	:

Provider Business Practice Location Address
First Line	:	8500 N MOPAC EXPY
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-8375
Country	:	US
Telephone Number	:	512-902-3282
Fax Number	:

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

Provider Enumeration Date	:	05/31/2022
Last Update Date	:	05/31/2022

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Directions to “ JESSICA SMART ” Practice Location

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