Provider Demographics
NPI:1114476850
Name:HOLLIS-SMITH, CEAN (LCDC, MAC)
Entity Type:Individual
Prefix:
First Name:CEAN
Middle Name:
Last Name:HOLLIS-SMITH
Suffix:
Gender:F
Credentials:LCDC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3267 BEE CAVES RD
Mailing Address - Street 2:SUITE 107-202
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6700
Mailing Address - Country:US
Mailing Address - Phone:512-633-4543
Mailing Address - Fax:
Practice Address - Street 1:3267 BEE CAVES RD
Practice Address - Street 2:SUITE 107-202
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-6700
Practice Address - Country:US
Practice Address - Phone:512-633-4543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12334101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)