Provider Demographics
NPI:1043760143
Name:SMITH, TRYMESHIA MAE DEE (RBT)
Entity Type:Individual
Prefix:
First Name:TRYMESHIA
Middle Name:MAE DEE
Last Name:SMITH
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4910 AIRPORT AVE STE D
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77471-5759
Mailing Address - Country:US
Mailing Address - Phone:281-239-1435
Mailing Address - Fax:281-239-0828
Practice Address - Street 1:4910 AIRPORT AVE STE F
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77471-5759
Practice Address - Country:US
Practice Address - Phone:281-239-1435
Practice Address - Fax:281-239-0828
Is Sole Proprietor?:No
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15-09482106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician