MEDICARE: NATASHA 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	106H00000X	Marriage & Family Therapist	205193	TX

General Provider Information

NPI Number	:	1649055203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATASHA SMITH

Provider Business Mailing Address
First Line	:	38 GRIGGS PT
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78254-2542
Country	:	US
Telephone Number	:	512-621-1128
Fax Number	:

Provider Business Practice Location Address
First Line	:	12274 BANDERA RD STE 122
Second Line	:
City	:	HELOTES
State	:	TX
Zip	:	78023-4387
Country	:	US
Telephone Number	:	210-500-6479
Fax Number	:

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

Provider Enumeration Date	:	08/30/2023
Last Update Date	:	08/30/2023

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