Provider Demographics
NPI:1033512785
Name:SMITH, NATHANIEL LEWIS (LPC)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:LEWIS
Last Name:SMITH
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7303 VAIL DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79118-8259
Mailing Address - Country:US
Mailing Address - Phone:970-260-4218
Mailing Address - Fax:
Practice Address - Street 1:7303 VAIL DR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79118-8259
Practice Address - Country:US
Practice Address - Phone:970-260-4218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-08
Last Update Date:2018-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77253101YP2500X
COLPP.0001332101YP2500X
WYPPC-915101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional