Provider Demographics
NPI:1023028982
Name:SMITH, GUY G (MS, LPC)
Entity Type:Individual
Prefix:
First Name:GUY
Middle Name:G
Last Name:SMITH
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 601122
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75360-1122
Mailing Address - Country:US
Mailing Address - Phone:214-361-1519
Mailing Address - Fax:972-509-1450
Practice Address - Street 1:6036 BIRCHBROOK DR APT 226
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-4470
Practice Address - Country:US
Practice Address - Phone:214-361-1519
Practice Address - Fax:972-509-1450
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7431101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1260LCOtherBLUE CROSS