Provider Demographics
NPI:1073621595
Name:SMITH, AMY WALKER (LCDC, LPC)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:WALKER
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCDC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 WOODED ACRES DR
Mailing Address - Street 2:STE. 270
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-4468
Mailing Address - Country:US
Mailing Address - Phone:254-300-4116
Mailing Address - Fax:254-300-4118
Practice Address - Street 1:1105 WOODED ACRES DR
Practice Address - Street 2:STE. 270
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-4468
Practice Address - Country:US
Practice Address - Phone:254-300-4116
Practice Address - Fax:254-300-4118
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19676101YP2500X
TX6993101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)