Provider Demographics
NPI:1235450529
Name:SMITH, SHANNON RENETTE (LPC-S)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:RENETTE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17000 EL CAMINO REAL STE 307A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-2661
Mailing Address - Country:US
Mailing Address - Phone:281-217-8486
Mailing Address - Fax:
Practice Address - Street 1:17000 EL CAMINO REAL STE 307A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2661
Practice Address - Country:US
Practice Address - Phone:281-217-8486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64460101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional