Provider Demographics
NPI:1063857431
Name:SMITH, BERNADETTE PEARLINE (EDD, LPC-S)
Entity Type:Individual
Prefix:DR
First Name:BERNADETTE
Middle Name:PEARLINE
Last Name:SMITH
Suffix:
Gender:F
Credentials:EDD, LPC-S
Other - Prefix:
Other - First Name:BERNADETTE
Other - Middle Name:PEARLINE
Other - Last Name:WESTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11601 SHADOW CREEK PKWY STE 111-659
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7283
Mailing Address - Country:US
Mailing Address - Phone:713-581-4527
Mailing Address - Fax:
Practice Address - Street 1:11601 SHADOW CREEK PKWY STE 111-659
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7283
Practice Address - Country:US
Practice Address - Phone:713-581-4527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-30
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67671101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional