Provider Demographics
NPI:1326419557
Name:SMITH, WAYNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 S STAPLES ST
Mailing Address - Street 2:SUITE 232
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-3846
Mailing Address - Country:US
Mailing Address - Phone:361-488-4130
Mailing Address - Fax:
Practice Address - Street 1:5959 S STAPLES ST
Practice Address - Street 2:SUITE 232
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-3846
Practice Address - Country:US
Practice Address - Phone:361-488-4130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-14
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health