Provider Demographics
NPI:1083014534
Name:SMITH, JOSH
Entity Type:Individual
Prefix:MR
First Name:JOSH
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JOSHUA
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:300 MONEY ST
Mailing Address - Street 2:
Mailing Address - City:GLADEWATER
Mailing Address - State:TX
Mailing Address - Zip Code:75647-2523
Mailing Address - Country:US
Mailing Address - Phone:888-877-3901
Mailing Address - Fax:866-224-2940
Practice Address - Street 1:300 MONEY ST
Practice Address - Street 2:
Practice Address - City:GLADEWATER
Practice Address - State:TX
Practice Address - Zip Code:75647-2523
Practice Address - Country:US
Practice Address - Phone:888-877-3901
Practice Address - Fax:866-224-2940
Is Sole Proprietor?:No
Enumeration Date:2014-09-02
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1544448103TB0200X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral