1457425191 NPI number — CATHERINE ANN SMITH M.ED., LPC

Table of content: CATHERINE ANN SMITH M.ED., LPC (NPI 1457425191)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457425191 NPI number — CATHERINE ANN SMITH M.ED., LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
CATHERINE
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.ED., LPC
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:
1457425191
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4402 LAKE SHORE DR APT D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WACO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76710-1949
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-733-5300
Provider Business Mailing Address Fax Number:
254-399-8325

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 WASHINGTON AVE
Provider Second Line Business Practice Location Address:
SUITE 402
Provider Business Practice Location Address City Name:
WACO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76701-1282
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-733-5300
Provider Business Practice Location Address Fax Number:
254-399-8325
Provider Enumeration Date:
11/17/2006

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: 101YP2500X , with the licence number:  18183 , 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)





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