1619083334 NPI number — MS. BILLIE L SMITHSON MA LPC

Table of content: MS. BILLIE L SMITHSON MA LPC (NPI 1619083334)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619083334 NPI number — MS. BILLIE L SMITHSON MA LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITHSON
Provider First Name:
BILLIE
Provider Middle Name:
L
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VINES
Provider Other First Name:
BILLIE
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1619083334
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4901 BROADWAY
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78209-5734
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-822-5795
Provider Business Mailing Address Fax Number:
210-822-5939

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4901 BROADWAY
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78209-5734
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-822-5795
Provider Business Practice Location Address Fax Number:
210-822-5939
Provider Enumeration Date:
08/23/2006

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:  10336 , 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: 1492LC . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com