Provider Demographics
NPI:1083783732
Name:SMITH, LISA A (LCSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 AUGUSTA DR
Mailing Address - Street 2:STE. 240
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-4922
Mailing Address - Country:US
Mailing Address - Phone:713-526-8383
Mailing Address - Fax:713-583-4546
Practice Address - Street 1:2400 AUGUSTA DR
Practice Address - Street 2:STE. 240
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-4922
Practice Address - Country:US
Practice Address - Phone:713-526-8383
Practice Address - Fax:713-583-4546
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX335441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical