Provider Demographics
NPI:1477762136
Name:SMITH, SHIRLEY L (LPC)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 S CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-6614
Mailing Address - Country:US
Mailing Address - Phone:281-357-0074
Mailing Address - Fax:281-516-1526
Practice Address - Street 1:333 S CHERRY ST
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-6614
Practice Address - Country:US
Practice Address - Phone:281-357-0074
Practice Address - Fax:281-516-1526
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69605101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional