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NPI Code Detail

MEDICARE: JUSTIN SMITH

MEDICARE: JUSTIN 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
1101YA0400XAddiction (Substance Use Disorder) Counselor15971TX

General Provider Information

NPI Number : 1639953763
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTIN SMITH
Provider Business Mailing Address
First Line : PO BOX 890
Second Line :
City : WACO
State : TX
Zip : 76703-0890
Country : US
Telephone Number : 254-752-3451
Fax Number :
Provider Business Practice Location Address
First Line : 2220 AUSTIN AVE
Second Line :
City : WACO
State : TX
Zip : 76701-1625
Country : US
Telephone Number : 254-752-3451
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2023
Last Update Date : 08/21/2023

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Directions to “ JUSTIN SMITH ” Practice Location

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