MEDICARE: MADELINE LORIN SMITH LMFT-ASSOCIATE

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	106H00000X	Marriage & Family Therapist	205223	TX

General Provider Information

NPI Number	:	1457123929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELINE LORIN SMITH LMFT-ASSOCIATE

Provider Business Mailing Address
First Line	:	13341 W HIGHWAY 290 UNIT 103
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78737-9160
Country	:	US
Telephone Number	:	512-829-4210
Fax Number	:

Provider Business Practice Location Address
First Line	:	13341 W HIGHWAY 290 UNIT 103
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78737-9160
Country	:	US
Telephone Number	:	512-829-4210
Fax Number	:

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

Provider Enumeration Date	:	10/26/2023
Last Update Date	:	10/26/2023

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