1285952317 NPI number — RACHEL ANNA SMITH MA, LPC, LCDC

Table of content: RACHEL ANNA SMITH MA, LPC, LCDC (NPI 1285952317)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285952317 NPI number — RACHEL ANNA SMITH MA, LPC, LCDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
RACHEL
Provider Middle Name:
ANNA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, LPC, LCDC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285952317
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3223 S LOOP 289 STE 145
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUBBOCK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79423-1336
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-370-0327
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1628 19TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79401-4832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-219-0500
Provider Business Practice Location Address Fax Number:
806-766-1286
Provider Enumeration Date:
05/13/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  11106 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 68624 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3172017-03 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 68624 . This is a "TEXAS BEHAVIORAL HEALTH EXECUTIVE COUNSEL" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 11106 . This is a "TEXAS DEPARTMENT OF STATE HEALTH SERVICES" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 3172017-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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