Provider Demographics
NPI:1407189558
Name:SMITH, DAVID G (LCDC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:G
Last Name:SMITH
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 50TH MANAGED CARE CENTER
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79412
Mailing Address - Country:US
Mailing Address - Phone:806-780-8300
Mailing Address - Fax:806-780-8383
Practice Address - Street 1:2345 50TH MANAGED CARE CENTER
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79412
Practice Address - Country:US
Practice Address - Phone:806-780-8300
Practice Address - Fax:806-780-8383
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10487101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX065363601Medicaid