Provider Demographics
NPI:1477663052
Name:SMITH, J. THOMAS (LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:J. THOMAS
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14403 WALTERS RD UNIT 681113
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77268-6045
Mailing Address - Country:US
Mailing Address - Phone:713-529-9800
Mailing Address - Fax:713-490-2682
Practice Address - Street 1:3707 CYPRESS CREEK PKWY STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77068-3525
Practice Address - Country:US
Practice Address - Phone:713-529-9800
Practice Address - Fax:713-490-2682
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YM0800X, 101YP2500X
GALPC001289101YM0800X
TXLP9818101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX025664603Medicaid