Provider Demographics
NPI:1265643654
Name:SMOCK, SARA ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:ANN
Last Name:SMOCK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4110 63RD ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79413-5024
Mailing Address - Country:US
Mailing Address - Phone:806-795-9585
Mailing Address - Fax:
Practice Address - Street 1:APPLIED AND PROFESSIONAL STUDIES,BROADWAY AND AKRON ST.
Practice Address - Street 2:RM 260, HUMAN SCIENCES, BOX 41162
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79409-1162
Practice Address - Country:US
Practice Address - Phone:806-742-5050
Practice Address - Fax:806-742-5033
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist