Provider Demographics
NPI:1336290139
Name:SMITH, PATTY A (MA, LMFT)
Entity Type:Individual
Prefix:MS
First Name:PATTY
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14812 AVERY RANCH BLVD APT 20
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-3941
Mailing Address - Country:US
Mailing Address - Phone:512-310-1798
Mailing Address - Fax:
Practice Address - Street 1:11615 ANGUS RD STE 224
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4066
Practice Address - Country:US
Practice Address - Phone:512-731-3613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX004946106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist