Provider Demographics
NPI:1447399068
Name:SMITH, WILLIAM J (MS, LPC, LSOTP)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:J
Last Name:SMITH
Suffix:
Gender:M
Credentials:MS, LPC, LSOTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 FLORENCE RD
Mailing Address - Street 2:SUITE 21
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76541-7979
Mailing Address - Country:US
Mailing Address - Phone:254-616-6601
Mailing Address - Fax:254-616-5978
Practice Address - Street 1:1519 FLORENCE RD
Practice Address - Street 2:SUITE 21
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76541-7979
Practice Address - Country:US
Practice Address - Phone:254-616-6601
Practice Address - Fax:254-616-5978
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207297101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7780082OtherCIGNA
TX84421LOtherBCBS