1861190878 NPI number — LINDSEY LEE HEDDLESTON SMITH LMSW

Table of content: LINDSEY LEE HEDDLESTON SMITH LMSW (NPI 1861190878)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861190878 NPI number — LINDSEY LEE HEDDLESTON SMITH LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEDDLESTON SMITH
Provider First Name:
LINDSEY
Provider Middle Name:
LEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HEDDLESTON
Provider Other First Name:
LINDSEY
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1861190878
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
503 W 33RD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78705-2320
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-262-1936
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
911 W 29TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78705-3506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-262-1936
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/20/2023

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: 104100000X , 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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