Provider Demographics
NPI:1164438198
Name:SMITH, MICKEY ORB (LCSW,)
Entity Type:Individual
Prefix:MR
First Name:MICKEY
Middle Name:ORB
Last Name:SMITH
Suffix:
Gender:M
Credentials:LCSW,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 WHISPER HOLLOW
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-9520
Mailing Address - Country:US
Mailing Address - Phone:254-933-2283
Mailing Address - Fax:
Practice Address - Street 1:1711 E CENTRAL TEXAS EXPY
Practice Address - Street 2:SUITE 103
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76541-9166
Practice Address - Country:US
Practice Address - Phone:254-526-7272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX249601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical